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

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.