Global prevalence of COPD-OSA overlap syndrome: A systematic review and meta-analysis

COPD-OSA overlap syndrome is an important and prevalent condition. Patients with the overlap syndrome experience more severe respiratory symptoms and worse quality of life, and the relative risk of exacerbations is higher than in either condition alone. Because prevalence estimates of COPD-OSA overlap syndrome vary substantially across studies, there is still no consensus on its exact global prevalence. This review specifically aims to offer a comprehensive overview of the global prevalence of the COPD-OSA overlap syndrome.

Embase, PubMed, Web of Science, Cochrane and Ovid Medline databases were systematically searched for studies reporting the prevalence of COPD-OSA overlap syndrome published from database inception until February 24, 2025. Random effects meta-analysis was performed using R software. Heterogeneity among the studies was evaluated using the I² index. Sensitivity analysis, subgroup analysis and meta-regression was conducted to evaluate the heterogeneity source of the results. Begg test was used to assess publication bias.

A total of 41 studies involving 1,871,071 participants were included in this analysis. The global prevalence of COPD-OSA overlap syndrome was 28.3 % (95 % CI: 20.8-36.4 %). Subgroup analysis revealed that the prevalence was higher in cross-sectional studies (30.66 %, 95 % CI: 21.66 %-40.47 %) compared with cohort studies (21.24 %, 95 % CI: 9.74 %-35.69 %). Among continents, Asia exhibited the highest prevalence at 37.87 % (95 % CI: 24.46 %-52.29 %). The prevalence of overlap syndrome when OSA was assessed by home sleep apnea test (HSAT) was comparable to that assessed by polysomnography (PSG), and a higher proportion of COPD-OSA overlap syndrome was observed when using an apnea-hypopnea index (AHI) threshold of ≥5 compared with an AHI threshold of ≥10. Meta-regression analysis highlighted that those differences in study period, study population, sample size, and age were pivotal factors influencing these epidemiological patterns.

Pooled analysis estimated that approximately one-third of patients exhibit COPD-OSA overlap syndrome, with this proportion increasing over time. Significant epidemiological differences were observed across populations, time periods, sample sizes, and age groups. To mitigate the adverse impact of COPD-OSA overlap syndrome on health outcomes, regular screening for individuals with COPD or OSA is recommended, along with the implementation of effective preventive and treatment strategies.