Obstructive Sleep Apnea in Bronchiectasis: Prevalence, Risk Factors and Clinical Implications-A Systematic Review and...

Obstructive sleep apnea (OSA) has been poorly characterised in patients with bronchiectasis despite potential bidirectional clinical impacts. This systematic review and meta-analysis determined the prevalence of OSA confirmed by polysomnography in cystic fibrosis and non-cystic fibrosis bronchiectasis patients. A comprehensive search of MEDLINE, EMBASE and Cochrane databases through September 2025 identified observational studies reporting polysomnography-confirmed OSA prevalence in adult bronchiectasis patients. Five studies encompassing 256 patients met inclusion criteria, with data extracted and quality assessed using the Newcastle-Ottawa Scale. The pooled obstructive sleep apnea prevalence was 50.5% (95% confidence interval: 42.3%-58.9%) with low heterogeneity, ranging from 40.4% to 64.3% in cystic fibrosis patients and 40.8% to 55.8% in non-cystic fibrosis bronchiectasis patients. Traditional risk factors including obesity and excessive daytime sleepiness showed weak associations, with a mean body mass index of 23.8-24.2 kg/m². Male gender, longer disease duration, and corticosteroid use emerged as significant risk factors. Nocturnal hypoxemia independent of obstructive sleep apnea occurred in 16.7% of patients. Only 41% of diagnosed patients received positive airway pressure therapy. OSA affects approximately half of all bronchiectasis patients regardless of aetiology, substantially exceeding general population rates. The clinical presentation differs from classical OSA, with weaker associations with obesity and daytime sleepiness, suggesting distinct pathophysiological mechanisms. Systematic screening should be incorporated into bronchiectasis management, particularly for male patients with longer disease duration or corticosteroid use.