Risk of obstructive sleep apnea among healthcare workers: a systematic review and meta-analysis

Obstructive sleep apnea (OSA) is a very common but underdiagnosed health disorder. OSA-derived cognitive disorders could increase the risk of work-related injuries among healthcare workers (HW), representing a major threat both to them and their patients. This study aimed to conduct a systematic review and meta-analysis to assess the relevance of OSA in the healthcare sector. Studies reporting the prevalence of either high risk of OSA (HRO) or diagnosed OSA, assessed respectively by structured questionnaires or validated diagnostic tools among healthcare workers, published between 2000 and 2026 in PubMed and Scopus were included. A meta-analysis of the included papers was performed using random-effects models to estimate the pooled prevalence. Variability was evaluated by the heterogeneity test and the I² statistic. Statistical significance was set at p < 5%. Of the 211 articles identified, 9 with 8473 participants were included in the meta-analysis. OSA risk was assessed by the Berlin (BQ) and STOP-BANG questionnaires (SBQ) in 6 and 3 studies, respectively. Prevalence estimates for HRO were highly heterogeneous (I-squared = 99.1%), ranging from 7 to 37%. The pooled estimate was 23% (95% CI 13-33%). Prevalence estimates were significantly affected by geographic area, being higher in Europe and the Middle East than in South-East Asia and the US (p < 0.01), but neither by response rate nor by the questionnaire used. The prevalence of OSA diagnosis was instrumentally obtained only in two studies and ranged from 9.3 to 21.9%. Data on HRO prevalence among HW are sparse, including a few studies with limited sample sizes and variable response rates. Larger studies, based on home sleep tests or new validated digital tools, such as smartwatches, smart pillows, and microphones, are warranted.