Detection rate and risk factors of carotid atherosclerotic plaque in patients with obstructive sleep apnea syndrome: A systematic review and meta-analysis.

BACKGROUND

Although the presence of carotid atherosclerosis plaque (CAP) is common in patients with obstructive sleep apnea syndrome (OSAS), the detection rate remains uncertain.

OBJECTIVE

This study systematically assesses the detection rate and correlates of carotid atherosclerotic plaque in OSAS patients.

METHODS

PubMed, Embase, and Cochrane Library were retrieved up to October 10, 2025. Data were logit-transformed to test for normality prior to pooling. A random-effects model was applied, and meta-regression and subgroup analyses were carried out to examine heterogeneity. All statistical analyses were implemented utilizing R. Reporting heterogeneity restricted systematic review to risk factors.

RESULTS

A total of 37 studies were included. The pooled detection rate of CAP among patients with OSAS was 36.85 % [95 % confidence interval (CI): 29.92 % to 44.37 %, I² = 95.8 %]. Subgroup analyses suggested a severity-related increase in CAP detection across mild, moderate, and severe OSAS groups (27.68 %, 42.13 %, and 47.36 %, respectively). The systematic review indicated that age, sex, smoking history, hypertension, type 2 diabetes, and hyperlipidemia were associated with CAP detection. Meta-regression showed that the overall detection rate increased with age (β = 0.0788, P = 0.0002), whereas publication year, apnea-hypopnea index (AHI), body mass index (BMI), and T90 % were not significant moderators of the estimated detection rate.

CONCLUSION

CAP detection rate is higher in OSAS patients, particularly among those with severe OSAS, older age, higher BMI, and elevated ODI and T90 %. Age, sex, smoking, hypertension, diabetes, and hyperlipidemia may be risk factors for CAP.