The prevalence of obstructive sleep apnea in adults with versus without cognitive impairment: A systematic review and meta-analysis

Christopher Chu; Khushboo Gupta; Aparna Saripella; Jinny Tsang; Sinead Campbell; Ellene Yan; Shad Islam; Maira Khan; Marina Englesakis; Michael Mak; Frances Chung

doi:10.1016/j.smrv.2026.102287

The prevalence of obstructive sleep apnea in adults with versus without cognitive impairment: A systematic review and meta-analysis

Sleep Med Rev. 2026 Aug:88:102287. doi: 10.1016/j.smrv.2026.102287. Epub 2026 Apr 3.

Authors

Affiliations

¹ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
² School of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland.
³ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
⁴ Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, University Health Network, ON, Canada.
⁶ Library & Information Services, University Health Network, Toronto, ON, Canada.
⁷ Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
⁸ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, University Health Network, ON, Canada. Electronic address: frances.chung@uhn.ca.

PMID: 42001820
DOI: 10.1016/j.smrv.2026.102287

Abstract

Obstructive sleep apnea (OSA) is characterized by repeated episodes of airway obstruction during sleep. These disruptions have been linked with cognitive impairment (CI). This systematic review and meta-analysis aims to estimate the prevalence of OSA in individuals with CI versus those without CI. Six databases were systematically searched from inception to August 13, 2024, with an update conducted through April 25, 2025. Eligible studies included adults diagnosed with CI using established criteria; OSA using validated screening tools; and studies in English. The primary outcome was the prevalence of OSA among individuals with CI compared to those without CI. Fifteen studies (n = 740,901) were included. OSA was more prevalent among individuals with CI than in those without CI (OR 1.57, 95% CI 1.31-1.88). OSA was more prevalent among individuals with MCI than those without MCI (OR 1.65, 95% CI 1.34-2.02). The prevalence of OSA was 50% (95% CI 0.41-0.58) among individuals with CI and 38% (95% CI 0.31-0.45) among those without CI. OSA was more prevalent among individuals with CI or MCI compared to those without CI. OSA is likely associated with CI, but further research is needed to determine the causal mechanisms and disease progression.

Keywords: Cognitive impairment; Dementia; Mild cognitive impairment; Obstructive sleep apnea; Sleep disordered breathing; Systematic review and meta-analysis.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Adult
Cognitive Dysfunction* / complications
Cognitive Dysfunction* / epidemiology
Humans
Prevalence
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / epidemiology