Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis
BackgroundPolycystic ovary syndrome (PCOS) has been associated with a high prevalence of obstructive sleep apnea syndrome (OSAS). However, the impact of OSAS on the PCOS symptom profile remains unclear. This systematic review and meta-analysis, which informed the 2023 International Evidence-based PC...
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Frontiers Media S.A.
2025-04-01
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| author | Nur K. Abdul Jafar Afra Al Balushi Anuradhaa Subramanian Siang Ing Lee Christie J. Bennett Lisa J. Moran Aya Mousa Chau Thien Tay Helena J. Teede Darren R. Mansfield |
| author_facet | Nur K. Abdul Jafar Afra Al Balushi Anuradhaa Subramanian Siang Ing Lee Christie J. Bennett Lisa J. Moran Aya Mousa Chau Thien Tay Helena J. Teede Darren R. Mansfield |
| author_sort | Nur K. Abdul Jafar |
| collection | DOAJ |
| description | BackgroundPolycystic ovary syndrome (PCOS) has been associated with a high prevalence of obstructive sleep apnea syndrome (OSAS). However, the impact of OSAS on the PCOS symptom profile remains unclear. This systematic review and meta-analysis, which informed the 2023 International Evidence-based PCOS Guideline, aims to assess the prevalence and related symptoms of OSAS among females with and without PCOS.MethodsA systematic search using databases (MEDLINE, Embase, EBM Reviews, PsycInfo and CINAHL) was performed until 16th May 2024. Random-effects restricted maximum likelihood meta-analyses compared OSAS and related symptoms between PCOS and non-PCOS groups. OSAS outcomes were categorized as apnea-hypopnea index (AHI)≥5 only, AHI≥5 with symptoms, AHI≥10 with symptoms and composite OSA (i.e., all AHI cut-offs with and/or without symptoms). Subgroup analyses by body mass index (BMI), age, PCOS diagnostic criteria and ethnicity were performed. Risk of bias and certainty of evidence by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were conducted.ResultsFrom 4438 records, 3205 titles/abstracts were screened and 40 were eligible for full-text screening. Eight cross-sectional studies met inclusion criteria and meta-analysis. The pooled prevalence of OSA was 37.0% in PCOS (29.0% adolescents; 40.0% adults) and 6.0% in non-PCOS. Compared with non-PCOS, those with PCOS showed higher risk for composite OSA (odds ratio (OR): 9.52; 95% CI: 3.90 to 23.26; I2 = 54.5%; 8 studies, n=942; P<0.001) and more pronounced OSAS risk with increasing symptom severity in PCOS (AHI≥5 OR: 3.90; 95% CI: 1.63 to 9.34; AHI≥5 with symptoms OR: 17.95; 95% CI: 6.17 to 52.22; AHI≥10 with symptoms OR: 30.61; 95% CI: 7.99 to 117.25, all P ≤ 0.0023). Subgroup results showed significantly higher risk of OSAS overall in overweight/obesity, adults and white ethnicity compared with normal weight, adolescent and Asian subgroups, respectively (all P<0.001), but independent of PCOS diagnostic criteria.ConclusionThe prevalence of OSA was higher in PCOS compared with non-PCOS groups, with the risk of OSAS increasing with worse symptom severity. Adults and those of higher BMI and of white ethnicity were at increased risk of OSAS. Hence, identifying and treating OSAS symptoms in PCOS may be beneficial, but further validation of findings is warranted. |
| format | Article |
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| institution | DOAJ |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-04-01 |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-e6275dfb1d8744f6917b4e60b7a943e92025-08-20T03:05:53ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-04-011610.3389/fendo.2025.15325191532519Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysisNur K. Abdul Jafar0Afra Al Balushi1Anuradhaa Subramanian2Siang Ing Lee3Christie J. Bennett4Lisa J. Moran5Aya Mousa6Chau Thien Tay7Helena J. Teede8Darren R. Mansfield9Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, AustraliaMonash Lung and Sleep, Monash Health, Clayton, VIC, AustraliaDepartment of Applied Health Sciences, University of Birmingham, Birmingham, United KingdomDepartment of Applied Health Sciences, University of Birmingham, Birmingham, United KingdomBe Active Sleep and Eat (BASE) Facility, Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, AustraliaMonash Centre for Health Research and Implementation, Monash University, Clayton, VIC, AustraliaMonash Centre for Health Research and Implementation, Monash University, Clayton, VIC, AustraliaMonash Centre for Health Research and Implementation, Monash University, Clayton, VIC, AustraliaMonash Centre for Health Research and Implementation, Monash University, Clayton, VIC, AustraliaMonash Lung and Sleep, Monash Health, Clayton, VIC, AustraliaBackgroundPolycystic ovary syndrome (PCOS) has been associated with a high prevalence of obstructive sleep apnea syndrome (OSAS). However, the impact of OSAS on the PCOS symptom profile remains unclear. This systematic review and meta-analysis, which informed the 2023 International Evidence-based PCOS Guideline, aims to assess the prevalence and related symptoms of OSAS among females with and without PCOS.MethodsA systematic search using databases (MEDLINE, Embase, EBM Reviews, PsycInfo and CINAHL) was performed until 16th May 2024. Random-effects restricted maximum likelihood meta-analyses compared OSAS and related symptoms between PCOS and non-PCOS groups. OSAS outcomes were categorized as apnea-hypopnea index (AHI)≥5 only, AHI≥5 with symptoms, AHI≥10 with symptoms and composite OSA (i.e., all AHI cut-offs with and/or without symptoms). Subgroup analyses by body mass index (BMI), age, PCOS diagnostic criteria and ethnicity were performed. Risk of bias and certainty of evidence by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were conducted.ResultsFrom 4438 records, 3205 titles/abstracts were screened and 40 were eligible for full-text screening. Eight cross-sectional studies met inclusion criteria and meta-analysis. The pooled prevalence of OSA was 37.0% in PCOS (29.0% adolescents; 40.0% adults) and 6.0% in non-PCOS. Compared with non-PCOS, those with PCOS showed higher risk for composite OSA (odds ratio (OR): 9.52; 95% CI: 3.90 to 23.26; I2 = 54.5%; 8 studies, n=942; P<0.001) and more pronounced OSAS risk with increasing symptom severity in PCOS (AHI≥5 OR: 3.90; 95% CI: 1.63 to 9.34; AHI≥5 with symptoms OR: 17.95; 95% CI: 6.17 to 52.22; AHI≥10 with symptoms OR: 30.61; 95% CI: 7.99 to 117.25, all P ≤ 0.0023). Subgroup results showed significantly higher risk of OSAS overall in overweight/obesity, adults and white ethnicity compared with normal weight, adolescent and Asian subgroups, respectively (all P<0.001), but independent of PCOS diagnostic criteria.ConclusionThe prevalence of OSA was higher in PCOS compared with non-PCOS groups, with the risk of OSAS increasing with worse symptom severity. Adults and those of higher BMI and of white ethnicity were at increased risk of OSAS. Hence, identifying and treating OSAS symptoms in PCOS may be beneficial, but further validation of findings is warranted.https://www.frontiersin.org/articles/10.3389/fendo.2025.1532519/fullpolycystic ovary syndromeobstructive sleep apnea syndromeOSASsystematic reviewmeta-analysis |
| spellingShingle | Nur K. Abdul Jafar Afra Al Balushi Anuradhaa Subramanian Siang Ing Lee Christie J. Bennett Lisa J. Moran Aya Mousa Chau Thien Tay Helena J. Teede Darren R. Mansfield Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis Frontiers in Endocrinology polycystic ovary syndrome obstructive sleep apnea syndrome OSAS systematic review meta-analysis |
| title | Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis |
| title_full | Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis |
| title_fullStr | Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis |
| title_full_unstemmed | Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis |
| title_short | Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis |
| title_sort | obstructive sleep apnea syndrome in polycystic ovary syndrome a systematic review and meta analysis |
| topic | polycystic ovary syndrome obstructive sleep apnea syndrome OSAS systematic review meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1532519/full |
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