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

Background Obstructive sleep apnea syndrome (OSAS) and sarcopenia are prevalent conditions associated with aging and metabolic disorders. Emerging evidence suggests a potential link between intermittent hypoxia and skeletal muscle impairment, but findings remain inconsistent. We conducted a meta-analysis to clarify the association between OSAS and sarcopenia in adults. Methods PubMed, Embase, Web of Science, Wanfang, and CNKI were searched for observational studies evaluating the association between OSAS and sarcopenia in adults. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models by incorporating the influence of potential heterogeneity. Subgroup and sensitivity analyses were performed to explore heterogeneity. Results Eight cross-sectional studies comprising 13,331 participants (3,572 with OSAS) were included. Overall, OSAS was significantly associated with sarcopenia (OR 1.85, 95% CI 1.30–2.63; I 2 = 62%). The association was stronger in Asian populations (OR 2.92) than in non-Asian populations (OR 1.33; p for subgroup difference < 0.001), and in older participants (mean age ≥ 64 years; OR 2.36 vs. 1.37; p for subgroup difference = 0.04). Studies using objective sleep assessment showed stronger associations than those using questionnaires or medical records (OR 2.78 vs. 1.33; p for subgroup difference < 0.001). Results were consistent in studies with NOS ≥ 8 (OR 1.82, 95% CI 1.23–2.70). Meta-regression analyses did not identify significant effect modifiers, although statistical power was limited by the small number of studies. No significant publication bias was detected (Egger’s p = 0.49). Conclusion OSAS is associated with increased odds of sarcopenia in adults, particularly in older and Asian populations and in studies using objective sleep assessment. However, given that all included studies were cross-sectional and that diagnostic criteria for both OSAS and sarcopenia varied across studies, these findings should be interpreted cautiously and do not imply causality. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420261324247.