The association between prediabetes and obstructive sleep apnea syndrome: a meta-analysis

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) has been increasingly linked to metabolic dysfunction. However, the association between prediabetes and OSAS remains incompletely defined. This meta-analysis aimed to systematically evaluate the relationship between prediabetes and the prevalence of OSAS in adults. METHODS: PubMed, Embase, and Web of Science were systematically searched to identify observational studies evaluating the association between prediabetes and objectively diagnosed OSAS. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models accounting for the influence of possible heterogeneity. RESULTS: Eight cross-sectional studies comprising 18,040 participants were included, of whom 6,325 (35.1%) had prediabetes. Overall, individuals with prediabetes exhibited a significantly higher prevalence of OSAS compared with normoglycemic controls (OR = 2.78, 95% CI 1.99-3.87; p < 0.001), with substantial heterogeneity (I² = 83%). Sensitivity analyses confirmed the robustness of the findings (OR range: 2.47-3.08). Consistent associations were observed across Asian and Western populations, community-derived and high-risk populations, and across different diagnostic methods for OSAS. A stronger association was noted among studies with younger populations (mean age < 55 years vs. ≥ 55 years: OR 3.44 vs. 2.06; p for subgroup difference = 0.04) and when prediabetes was defined using composite diagnostic criteria rather than single criteria (OR 3.40 vs. 1.92; p = 0.01). CONCLUSIONS: Prediabetes is significantly associated with a higher prevalence of OSAS in adults. These findings highlight the frequent coexistence of early glucose dysregulation and sleep-disordered breathing and support consideration of OSAS screening in individuals with prediabetes. SYSTEMATIC REVIEW REGISTRATION: , identifier CRD420261296015.