The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults
Neda Esmaeili, L. Gell, Théo Imler, Mohammadreza Hajipour, Luigi Taranto‐Montemurro, Ludovico Messineo, Katie L. Stone, Scott A. Sands, Najib Ayas, John Yee, John Cronin, Raphaël Heinzer, Andrew Wellman, Susan Redline, Ali Azarbarzin
Abstract
Background: Obesity is a well-established risk factor for obstructive sleep apnea (OSA). We assessed the reciprocal prevalence of obesity and OSA and how it varies by age and sex. Methods: Following a systematic review through March 27, 2025, the final sample included four community-based cohort studies in the US and Switzerland. OSA severity was quantified using the apnea-hypopnea index (AHI, all apneas plus hypopneas with ≥4% oxygen desaturation/hour). Random effects individual participant data (IPD) meta-analyses estimated prevalences. Logistic regression compared odds of OSA across weight groups. Findings: were 2.18 [1.73-2.76] and 4.84 [3.09-6.00], respectively. Interpretation: Our analyses show that most adults with OSA do not have obesity, with 44.4% having overweight and 23.5% having normal weight or underweight. Obesity was more prevalent among females compared to males and in younger individuals (<65 years) compared to older individuals with OSA. Recognizing OSA is not exclusive to obesity highlights the need for personalized treatment plans. Funding: American Academy of Sleep Medicine, National Heart, Lung, and Blood Institute, and Apnimed.