Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis
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Date
2025
Authors
Abdul Jafar, N.K.
Al Balushi, A.
Subramanian, A.
Lee, S.I.
Bennett, C.J.
Moran, L.J.
Mousa, A.
Tay, C.T.
Teede, H.J.
Mansfield, D.R.
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Frontiers in Endocrinology, 2025; 16
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Nur K. Abdul Jafar, Afra Al Balushi, Anuradhaa Subramanian, Siang Ing Lee, Christie J. Bennett, Lisa J. Moran, Aya Mousa, Chau Thien Tay, Helena J. Teede, and Darren R. Mansfield
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Background: Polycystic ovary syndrome (PCOS) has been associated with a high prevalence of obstructive sleep apnea syndrome (OSAS). However, the impact of OSAS on the PCOS symptom profile remains unclear. This systematic review and meta-analysis, which informed the 2023 International Evidence-based PCOS Guideline, aims to assess the prevalence and related symptoms of OSAS among females with and without PCOS. Methods: A systematic search using databases (MEDLINE, Embase, EBM Reviews, PsycInfo and CINAHL) was performed until 16th May 2024. Random-effects restricted maximum likelihood meta-analyses compared OSAS and related symptoms between PCOS and non-PCOS groups. OSAS outcomes were categorized as apnea-hypopnea index (AHI)≥5 only, AHI≥5 with symptoms, AHI≥10 with symptoms and composite OSA (i.e., all AHI cut-offs with and/or without symptoms). Subgroup analyses by body mass index (BMI), age, PCOS diagnostic criteria and ethnicity were performed. Risk of bias and certainty of evidence by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were conducted. Results: From 4438 records, 3205 titles/abstracts were screened and 40 were eligible for full-text screening. Eight cross-sectional studies met inclusion criteria and meta-analysis. The pooled prevalence of OSA was 37.0% in PCOS (29.0% adolescents; 40.0% adults) and 6.0% in non-PCOS. Compared with non-PCOS, those with PCOS showed higher risk for composite OSA (odds ratio (OR): 9.52; 95% CI: 3.90 to 23.26; I² = 54.5%; 8 studies, n=942; P<0.001) and more pronounced OSAS risk with increasing symptom severity in PCOS (AHI≥5 OR: 3.90; 95% CI: 1.63 to 9.34; AHI≥5 with symptoms OR: 17.95; 95% CI: 6.17 to 52.22; AHI≥10 with symptoms OR: 30.61; 95% CI: 7.99 to 117.25, all P ≤ 0.0023). Subgroup results showed significantly higher risk of OSAS overall in overweight/ obesity, adults and white ethnicity compared with normal weight, adolescent and Asian subgroups, respectively (all P<0.001), but independent of PCOS Conclusion: The prevalence of OSA was higher in PCOS compared with non- PCOS groups, with the risk of OSAS increasing with worse symptom severity. Adults and those of higher BMI and of white ethnicity were at increased risk of OSAS. Hence, identifying and treating OSAS symptoms in PCOS may be beneficial, but further validation of findings is warranted. diagnostic criteria.
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© 2025 Abdul Jafar, Al Balushi, Subramanian, Lee, Bennett, Moran, Mousa, Tay, Teede and Mansfield. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.