Association Between Obstructive Sleep Apnea and Cardiovascular Risk: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Abstract

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent disorder associated with increased cardiovascular (CV) risk. Materials and Methods: We conducted a PRISMA-compliant systematic review and meta-analysis of prospective cohort studies assessing OSA and incident CV outcomes. Results: From 2463 records, 18 studies (>25,000 participants; median follow-up 9 years) were included. OSA was associated with increased CV risk (pooled HR 1.82, 95% CI 1.45–2.28). Dose–response analysis showed a progressive risk increase: mild OSA (HR 1.21, 95% CI 0.98–1.50), moderate (HR 1.56, 95% CI 1.20–2.03), and severe (HR 2.45, 95% CI 1.85–3.25). Continuous positive airway pressure (CPAP) adherence (≥4 h/night) reduced risk (HR 0.76, 95% CI 0.60–0.96). Conclusions: OSA confers a severity-dependent CV risk, which is mitigated by adequate CPAP adherence. Systematic screening and adherence support may reduce CV morbidity and mortality. PROSPERO: CRD420251168363.