Association between obstructive sleep apnea syndrome and metabolic syndrome: a severity-stratified meta-analysis

This study aimed to systematically investigate the association between obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MetS), with a particular focus on severity-stratified analysis, in order to clarify the differential risks of MetS and its components (hypertension, hyperglycemia, etc. ) among patients with different levels of OSAS severity.

A comprehensive literature search was conducted in Web of Science, PubMed, Cochrane, and Embase databases from their inception to June 1, 2025, using keywords related to "sleep apnea syndrome" and "MetS". After rigorous quality evaluation and data extraction of the included studies, a stratified meta-analysis by OSAS severity was performed using Stata 17.0 software.Subgroup analysis and meta-regression were further applied to explore heterogeneity sources, enhancing the reliability of results.

A total of 10 studies involving 10,205 participants were included. The meta-analysis revealed that the risk of developing MetS in patients with moderate-to-severe OSAS was 2.18 times higher than in those with mild OSAS (OR = 2.18, 95%CI:1.30-3.68, P < 0.001). The risk of hypertension in patients with moderate-to-severe OSAS was 2.19 times higher than that in patients with mild OSAS (OR = 2.19, 95%CI:1.57-3.06, P < 0.05). The risk of hyperglycemia in patients with moderate-to-severe OSAS was 1.50 times higher than that in patients with mild OSAS(OR = 1.50, 95%CI:1.01-2.18). Subgroup analysis results showed that heterogeneity existed between studies published before 2016 (I ² = 54.6%, P = 0.051) and those published in or after 2016 (I ² = 65.2%, P = 0.035). Meta-regression analysis indicated that the heterogeneity in the results of studies on the association between OSAS and the risk of MetS was primarily due to the year of publication of the literature (2016).

This study found that patients with moderate to severe OSAS have a 2.18 times higher risk of developing MetS than those with mild OSAS. Their risk of hypertension and hyperglycemia also goes up significantly. For patients with moderate to severe OSAS, it makes sense to prioritize MetS screening and start early intervention to lower their risk of developing MetS.

https://www.crd.york.ac.uk/PROSPERO/.