Prevalence of cognitive impairment among adults with obstructive sleep apnea: a systematic review and meta-analysis
Bibliographic record
Abstract
PURPOSE: Cognitive impairment in obstructive sleep apnea (OSA) poses a growing public health challenge. This systematic review and meta-analysis aims to estimate the prevalence of cognitive impairment among adults with OSA. METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from database inception to February 2, 2025 for studies on cognitive impairment in OSA adults. OSA diagnosis requires formal clinical confirmation through objective testing; cognitive impairment is assessed using validated standardized instruments. Meta-analysis was executed via Stata 17.0, with publication bias assessed by funnel plots and Egger's test. RESULTS: Across 23 studies involving 33,226 individuals, the pooled prevalence of cognitive impairment among adult OSA patients was 36.92% (95% CI: 26.62-47.23). Subgroup analyses indicated that the prevalence of 32.22% (95% CI: 12.57-55.60) in mild OSA cases, 36.79% (95% CI: 11.13-67.06) in moderate cases, and 44.46% (95% CI: 30.38-58.98) in severe cases; polysomnography (PSG)-based studies reported a higher prevalence at 38.61% (95% CI: 31.94-45.27) than home sleep apnea testing (HSAT) at 26.85% (95% CI: 19.34-34.36). Prevalence varied significantly by cognitive assessment tool: Montreal Cognitive Assessment (MoCA) yielded 42.20% (95% CI: 34.83-49.57), Mini-Mental State Examination (MMSE) 17.51% (95% CI: 14.07-20.94), Clinical Dementia Rating (CDR) 54.24% (95% CI: 40.75-67.28), and Critical Flicker Frequency (CFF) 27.66% (95% CI: 15.62-42.64). The South-East Asia Region exhibited the highest pooled prevalence at 62.32% (95% CI: 56.86-67.78), followed by the Western Pacific Region at 37.70% (95% CI: 28.50-46.91), the Region of the Americas at 34.21% (95% CI: 5.68-62.74), the Eastern Mediterranean Region at 33.25% (95% CI: 29.91-36.71), and the European Region at 24.89% (95% CI: 19.26-30.52); 46.98% (95% CI, 27.86-66.10) in males and 59.24% (95% CI, 53.20-65.29) in females. CONCLUSION: The high prevalence of cognitive impairment among adults with OSA highlights the need for increased attention from public health departments. Multinational longitudinal studies using standardized protocols are needed to optimize relevant evidence-based management strategies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.039 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".