Sleep apnea in interstitial lung disease: A systematic review and meta-analysis of prevalence, severity, and risk factors.

BACKGROUND

Obstructive sleep apnea (OSA) is common in interstitial lung disease (ILD) patients and affects disease progression and outcomes. This meta-analysis aims to estimate OSA prevalence in ILD and examine associations with lung function parameters and risk factors.

METHODS

PubMed, Embase, and Cochrane Library were searched for studies assessing OSA prevalence or apnea-hypopnea index (AHI) in ILD, published before February 2025. Primary outcomes were OSA prevalence and severity (assessed by AHI). Secondary outcomes assessed the influence of forced vital capacity (FVC), diffusing capacity of the lungs for carbon monoxide (DLCO), 6-min walk distance (6MWD), BMI, smoking rate, and male percentage. The study protocol was registered in PROSPERO (CRD420250650698).

RESULTS

17 studies comprising 1092 participants were included. Meta-analysis revealed an OSA prevalence of 68 % (95 % CI: 59-75 %), with higher rates in IPF (71 %, 95 % CI: 61-80 %) than non-IPF ILD. The pooled mean AHI was 13.36 (95 % CI: 10.87-16.41); moderate-to-severe OSA prevalence was 36 %. In multivariate analysis, OSA prevalence was associated with lower FVC (P = 0.086), male sex (P < 0.05), and BMI (P = 0.065-0.081). AHI was mildly associated with 6MWD (P = 0.086) and BMI (P = 0.065-0.084). Subgroup analyses identified that ILD patients with FVC < 80 % (P = 0.065), 6MWD < 372 m (P = 0.036), and BMI > 31 kg/m2 (P = 0.21) were at increased risk for OSA.

CONCLUSION

Given the high OSA prevalence in ILD patients, routine screening-particularly in males with FVC < 80 % predicted, BMI > 31 kg/m2, or 6MWD < 372 m-is recommended. Early detection may enable timely intervention and improve outcomes.