The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults.
Level 3 - non-randomized controlled study
Systematic review and individual participant data meta-analysis of observational cohort studies
PubMed 40330547 · doi:10.1016/j.eclinm.2025.103221
What was done
An individual participant data (IPD) meta-analysis of four community-based cohort studies conducted in the United States and Switzerland, identified through a systematic review through March 2025. Obstructive sleep apnea (OSA) was quantified using the apnea-hypopnea index (AHI ≥5 events/hour with ≥4% oxygen desaturation). Random-effects IPD meta-analyses and logistic regression were used to evaluate reciprocal prevalences and odds of OSA across body mass index (BMI) categories (normal/underweight <25, overweight 25 to <30, obesity ≥30 kg/m²), stratified by age and sex.
What was found
In 12,860 participants (mean age 66.6 ± 7.3 years), overall OSA prevalence was 56.2% (n = 7,222) and obesity prevalence was 25.7% (n = 3,309). Among adults with OSA, 31.5% (95% CI: 16.8–48.5%) had obesity, 44.4% (95% CI: 36.5–52.5%) were overweight, and 23.5% were normal or underweight. Conversely, OSA was present in 74.3% (95% CI: 63.8–83.5%) of adults with obesity and 59.8% (95% CI: 46.5–75.7%) of those with overweight. Compared with BMI <25 kg/m², the odds ratio for OSA was 2.18 (95% CI: 1.73–2.76) for overweight and 4.84 (95% CI: 3.09–6.00) for obesity. Obesity was more common among females than males with OSA, and in adults aged <65 versus ≥65 years.
Why it matters
Although obesity substantially multiplies the odds of sleep-disordered breathing, most adults living with OSA are not obese. Clinical screening pathways that treat OSA predominantly as a disease of obesity risk missing a large proportion of affected individuals.
Limits
Data were pooled from only four cohorts in two countries (US and Switzerland), limiting generalizability. The analyzed cohort was older (mean age ~67 years), which may affect baseline OSA prevalence. The abstract does not report longitudinal weight trajectories or adjust for non-BMI confounding variables.
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- supports Obstructive sleep apnea is strongly associated with gout and obesity.