The association between obstructive sleep apnea and metabolic abnormalities in women with polycystic ovary syndrome: a systematic review and meta-analysis
Open accessAbstract
Study Objectives: In this systematic review and meta-analysis, we aimed to examine the relationship between obstructive sleep apnea (OSA) and metabolic abnormalities in women with polycystic ovary syndrome (PCOS). Methods: Electronic databases (Medline, Embase, Cinahl, PsycInfo, Scopus, Web of Science, Opengrey, and CENTRAL), conference abstracts, and reference lists of relevant articles were searched. No restriction was applied for language or publication status. Results: Six studies involving 252 participants were included. Women with PCOS and OSA had significantly higher body mass index (mean difference [MD]: 6.01 kg/m2, 95% confidence intervals [CI]: 4.69-7.33), waist circumference (MD: 10.93 cm, 95% CI: 8.03-13.83), insulin resistance, systolic and diastolic blood pressure, and worse lipids' profile and impaired glucose regulation compared with women with PCOS without OSA. Most studies did not adjust for weight in their between-groups analysis. Total and free testosterone levels were not significantly different between the two groups. The majority of studies were found to be at high risk of selection bias, did not account for important confounders, were conducted in one country (United States), and used different methodologies to assess testosterone levels (preventing a meta-analysis for this specific outcome). Conclusions: OSA is associated with obesity and worse metabolic profiles in women with PCOS. However, whether the effects of OSA are independent of obesity remain unclear. As OSA is a treatable condition, research focused on the independent effects of OSA on key clinical outcomes in women with PCOS, including fertility, psychological health, type 2 diabetes, and cardiovascular risk, is lacking and needed. PROSPERO registration number: CRD42016048587.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Compared to previous meta-analyses, the present study showed relatively higher pooled OSA prevalence (37.0% vs 20.8-35.0%) and higher risk of OSAS (OR 9.52 vs ORs 2.86-8.30) in women with PCOS relative to without PCOS.
“Compared to previous meta-analyses, the present study showed relatively higher pooled OSA prevalence (37.0% vs. 20.8-35.0%) and higher risk of OSAS (OR: 9.52 vs. ORs: 2.86-8.30) in women with PCOS relative to without PCOS (14, 22, 26).”
From Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis (2025) · cites this paper as [14]
The Discussion (p. 7) says several studies suggest OSA is more prevalent in women with PCOS than in women without PCOS. It does not report the cited prevalence range of 20.8–35.0% or odds-ratio range of 2.86–8.30; this review primarily compares metabolic outcomes among women with PCOS with and without OSA. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA Group* (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00135 · Cited by 37,554 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)
Grundy, S. M., Becker, D. M., Clark, L. T., Cooper, R., Denke, M. A., Howard, J. L., Hunninghake, D. B., Illingworth, D. R., Luepker, R. V., McBride, P. E., et al. (2002) · Civil War Book Review · Cited by 12,198 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00136 · Cited by 10,349 · see citing works
The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993) · New England Journal of Medicine · doi:10.1056/nejm199304293281704 · Cited by 10,183 · cited 1× · see citing works
“Obesity is a major risk factor for OSA [26].”
BackgroundObesity and the Metabolic Syndrome in Children and Adolescents
Weiss, R., Dziura, J., Burgert, T. S., Tamborlane, W. V., Taksali, S. E., Yeckel, C. W., Allen, K., Lopes, M., Savoye, M., Morrison, J. A., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa031049 · Cited by 3,458 · see citing works
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6506 · Cited by 3,253 · see citing works
Fauser, B. C. J. M., Tarlatzis, B. C., Rebar, R. W., Legro, R. S., Balen, A. H., Lobo, R., Carmina, E., Chang, J., Yildiz, B. O., Laven, J. S. E., et al. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.09.024 · Cited by 1,976 · see citing works
Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K. M., Murad, M. H., Pasquali, R., & Welt, C. K. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-2350 · Cited by 1,919 · see citing works
Unwin, N. C. (2006) · Cited by 1,661 · see citing works
Kim, S. Y., Park, J. E., Lee, Y. J., Seo, H.-J., Sheen, S.-S., Hahn, S., Jang, B.-H., & Son, H.-J. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.09.016 · Cited by 1,165 · see citing works
Moran, L. J., Misso, M. L., Wild, R. A., & Norman, R. J. (2010) · Human Reproduction Update · doi:10.1093/humupd/dmq001 · Cited by 1,108 · see citing works
Engleman, H. M. (2004) · Thorax · doi:10.1136/thx.2003.015867 · Cited by 394 · see citing works
Quality of life and psychological well being in polycystic ovary syndrome
Barnard, L., Ferriday, D., Guenther, N., Strauss, B. M., Balen, A. H., & Dye, L. (2007) · Human Reproduction · doi:10.1093/humrep/dem108 · Cited by 388 · see citing works
Clinical and psychological correlates of quality-of-life in polycystic ovary syndrome
Hahn, S., Janssen, O. E., Tan, S., Pleger, K., Mann, K., Schedlowski, M., Kimmig, R., Benson, S., Balamitsa, E., & Elsenbruch, S. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.02024 · Cited by 387 · see citing works
Vgontzas, A. N., Legro, R. S., Bixler, E. O., Grayev, A., Kales, A., & Chrousos, G. P. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.2.7185 · Cited by 371 · see citing works
Cardiometabolic Aspects of the Polycystic Ovary Syndrome
Randeva, H. S., Tan, B. K., Weickert, M. O., Lois, K. B., Nestler, J. E., Sattar, N. A., & Lehnert, H. (2012) · Endocrine Reviews · doi:10.1210/er.2012-1003 · Cited by 329 · see citing works
Self-citationFogel, R. B., Malhotra, A., Pillar, G., Pittman, S. D., Dunaif, A., & White, D. P. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.3.7316 · Cited by 274 · see citing works
Akashiba, T., KAWAHARA, S., Akahoshi, T., Omori, C., Saitô, O., Majima, T., & Horie, T. (2002) · CHEST Journal · doi:10.1378/chest.122.3.861 · Cited by 265 · see citing works
Tahrani, A. A., Ali, A., Raymond, N. T., Begum, S., Dubb, K., Mughal, S., Jose, B., Piya, M. K., Barnett, A. H., & Stevens, M. J. (2012) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201112-2135oc · Cited by 196 · see citing works
Self-citationEffects of CPAP on oxidative stress and nitrate efficiency in sleep apnoea: a randomised trial
Alonso‐Fernández, A., Rio, F. G., Arias, M. A., Hernánz, Á., de la Peña, M., Piérola, J., Barceló, A., López‐Collazo, E., & Agustí, A. G. N. (2008) · Thorax · doi:10.1136/thx.2008.100537 · Cited by 184 · see citing works
Depression, anxiety and cardiometabolic risk in polycystic ovary syndrome
Cinar, N., Kizilarslanoglu, M. C., Harmanci, A., Aksoy, D. Y., Bozdag, G., Demir, B., & Yildiz, B. O. (2011) · Human Reproduction · doi:10.1093/humrep/der338 · Cited by 168 · see citing works
Finn, L. A., Young, T. B., Palta, M., & Fryback, D. G. (1998) · SLEEP · doi:10.1093/sleep/21.7.701 · Cited by 165 · see citing works
Sleep Apnea and Glucose Metabolism
Lindberg, E., Theorell-Haglöw, J., Svensson, M., Gislason, T., Berne, C., & Janson, C. (2012) · Chest · doi:10.1378/chest.11-1844 · Cited by 162 · see citing works
Ethnic differences in the phenotypic expression of polycystic ovary syndrome
Zhao, Y., & Qiao, J. (2013) · Steroids · doi:10.1016/j.steroids.2013.04.006 · Cited by 152 · see citing works
Gender and Obstructive Sleep Apnea Syndrome, Part 2: Mechanisms
Kapsimalis, F., & Kryger, M. H. (2002) · SLEEP · doi:10.1093/sleep/25.5.497 · Cited by 146 · see citing works
Tasali, E., Chapotot, F., Leproult, R., Whitmore, H. R., & Ehrmann, D. A. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-1187 · Cited by 126 · see citing works
Tasali, E., Van Cauter, E., Hoffman, L., & Ehrmann, D. A. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0925 · Cited by 111 · see citing works
Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study
Altaf, Q. A., Dodson, P. M., Ali, A., Raymond, N. T., Wharton, H., Fellows, H., Hampshire-Bancroft, R., Shah, M., Shepherd, E., Miah, J., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201701-0175oc · Cited by 104 · see citing works
Self-citationKahal, H., Kyrou, I., Tahrani, A. A., & Randeva, H. S. (2017) · Clinical Endocrinology · doi:10.1111/cen.13392 · Cited by 70 · see citing works
Self-citationPalep-Singh, M., Picton, H., Vrotsou, K., Maruthini, D., & Balen, A. H. (2007) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2007.02.005 · Cited by 68 · see citing works
Sleep and cardiometabolic function in obese adolescent girls with polycystic ovary syndrome
Nandalike, K., Agarwal, C., Strauss, T., Coupey, S. M., Isasi, C. R., Sin, S., & Arens, R. (2012) · Sleep Medicine · doi:10.1016/j.sleep.2012.07.002 · Cited by 68 · see citing works
Metabolic dysfunction in PCOS: Relationship to obstructive sleep apnea
Ehrmann, D. A. (2011) · Steroids · doi:10.1016/j.steroids.2011.12.001 · Cited by 59 · see citing works
Obstructive sleep apnoea and diabetes
Tahrani, A. A., Ali, A., & Stevens, M. J. (2013) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0b013e3283659da5 · Cited by 56 · see citing works
Self-citationObstructive sleep apnoea in diabetes: Does it matter?
Tahrani, A. A. (2017) · Diabetes and Vascular Disease Research · doi:10.1177/1479164117714397 · Cited by 52 · see citing works
Self-citationAmin, A., Ali, A., Altaf, Q. A., Piya, M. K., Barnett, A. H., Raymond, N. T., & Tahrani, A. A. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6548 · Cited by 50 · see citing works
Self-citationWest, S., Vahasarja, M., Bloigu, A. H., Pouta, A. M., Franks, S., Hartikainen, A., Järvelin, M., Corbett, S. J., Vääräsmäki, M., & Morin-Papunen, L. C. (2013) · Human Reproduction · doi:10.1093/humrep/det437 · Cited by 49 · see citing works
Chatterjee, B., Suri, J., Suri, J. C., Mittal, P., & Adhikari, T. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.06.023 · Cited by 47 · see citing works
Tock, L., Carneiro, G., Togeiro, S. M., Hachul, H., Pereira, A. Z., Tufik, S., & Zanella, M. T. (2013) · Endocrine Practice · doi:10.4158/ep12366.or · Cited by 35 · see citing works
(2014) · doi:10.1007/978-1-4471-2789-5_13 · Cited by 23 · see citing works
Tahrani, A. A. (2015) · Wiley eBooks · doi:10.1002/9781118387658.ch22 · Cited by 13 · see citing works
Self-citationTahrani, A. A. (2017) · Respirology · doi:10.1111/resp.13057 · Cited by 3 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 3
- [5]5. Kyrou I, et al. Diagnosis and management of Polycystic Ovary Syndrome (PCOS). In: Ajjan R, Orme SM, eds. Endocrinology and Diabetes . London: Springer; 2015: 99-113.
- [30]30. Legro RS, et al. ; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab . 2013; 98 (12):4565-4592.
- [6]6. stimulation with reduced fertilization and ongoing pregnancy rates than their Caucasian counterparts. Eur J Obstet Gynecol Reprod Biol . 2007; 134 (2):202-207.
Cited by
Sorted by citations
Kahal, H., Kyrou, I., Uthman, O. A., Brown, A., Johnson, S., Wall, P. D. H., Metcalfe, A., Parr, D. G., Tahrani, A. A., & Randeva, H. S. (2020) · Sleep and Breathing · doi:10.1007/s11325-019-01835-1 · Cited by 87 · see citing works
Self-citationRole of obstructive sleep apnea in metabolic risk in PCOS
Sam, S., & Tasali, E. (2021) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2021.01.002 · Cited by 21 · see citing works
Polycystic ovary syndrome in obstructive sleep apnea-hypopnea syndrome: an updated meta-analysis
He, J., Ruan, X., & Li, J. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1418933 · Cited by 16 · see citing works
Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis
Abdul Jafar, N. K., Al Balushi, A., Subramanian, A., Lee, S. I., Bennett, C. J., Moran, L. J., Mousa, A., Tay, C. T., Teede, H. J., & Mansfield, D. R. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1532519 · Cited by 15 · see citing works
Beyond counting sheep: Exploring the link between polycystic ovary syndrome and sleep health
Jafar, N. K. A., Bennett, C. J., Moran, L. J., & Mansfield, D. R. (2023) · Seminars in Reproductive Medicine · doi:10.1055/s-0043-1777724 · Cited by 12 · see citing works
- Authors
- Kahal, H., Kyrou, I., Uthman, O., Brown, A., Johnson, S., Wall, P., Metcalfe, A., Tahrani, A. A., & Randeva, H. S.
- Affiliations
- University Hospital Coventry (GB)
- Aston University (GB)
- University of Warwick (GB)
- Heartlands Hospital (GB)
- Corresponding author
- Randeva, Harpal S
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-05-02
- Volume
- 41
- Issue
- 7
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W2800802821
- Cited by
- 49
- References
- 46
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 5 · 2019: 7 · 2017: 1
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (CS-2013-13-029)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, polycystic ovary syndrome, metabolic abnormalities, obesity, insulin resistance, blood pressure, lipid profile, prediabetes, testosterone, women
- MeSH terms
- Blood Pressure, Diabetes Mellitus, Type 2, Female, Humans, Insulin Resistance, Obesity, Polycystic Ovary Syndrome, Body Mass Index, Sleep Apnea, Obstructive, Metabolic Syndrome, Waist Circumference
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
