Aims/background: Obstructive sleep apnea (OSA) and polycystic ovary syndrome (PCOS) share pathogenic pathways. Our review and meta-analysis estimated OSA prevalence in PCOS patients.
Methods: Systematic search of four databases was performed: MEDLINE, Scopus, EMBASE, Cochrane Central Register of Controlled Trials from inception until 1 March 2024. Grey literature was explored via Google Scholar. The following keywords were adopted: "obstructive sleep apnea", "OSA", "sleep-disordered breathing", and "polycystic ovary syndrome". OSA was diagnosed through polysomnography. Observed heterogeneity was evaluated using both Cochran's Q test (p < 0.10) and the I2 statistic. A random-effects model was applied when significant heterogeneity was detected, with the between-study variance (τ2) estimated using the DerSimonian-Laird method.
Results: We included 16 studies in the qualitative analysis and 13 in the quantitative analysis, comprising a total of 230,293 patients, including 148,378 in the control group and 81,915 in the PCOS group. Under the common effect model, the OSA pooled risk ratio in the PCOS group was 2.53 (95% confidence interval [CI]: 2.19-2.92), and 3.55 (95% CI: 1.98-6.37) under the random-effects model. Individual risk ratio ranged between 1.50-25.58. Significant heterogeneity was observed (I2 = 73.8%, τ2 = 0.4605, p = 0.0004), suggesting potential publication bias based on funnel plot analysis.
Conclusion: High prevalence of OSA was evidenced in PCOS women. These findings highlighted a significant association between these two conditions and the need for targeted screening or management in these high-risk patients. Further study to investigate these bidirectional relationships is needed.
Systematic review registration: PROSPERO (CRD42024524008).
Keywords: insulin resistance; metabolic syndrome; obstructive sleep apnea; polycystic ovary syndrome; polysomnography; prevalence; sleep disorders.
Copyright: © 2026 The Author(s). Published by IMR Press.