Obstructive sleep apnea and the risk of sudden cardiac death: a systematic review and meta-analysis.

BACKGROUND: Obstructive sleep apnea (OSA) has been linked to adverse cardiovascular outcomes, but its role as a risk factor for sudden cardiac death (SCD) remains uncertain. This systematic review and meta-analysis aimed to evaluate the association between OSA and SCD and assess the influence of disease severity and treatment. METHODS: A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was conducted up to January 17, 2025. We included observational studies reporting the association between OSA and SCD. Data were pooled using a random-effects model. Subgroup analyses were performed based on apnea-hypopnea index (AHI) and CPAP treatment. A separate meta-analysis examined adjusted odds ratios (aORs). Heterogeneity was assessed using the I² statistic, and publication bias was evaluated via funnel and Galbraith plots. RESULTS: Twelve studies (527,069 participants: 18,084 OSA, 508,985 non-OSA) were included. The pooled odds ratio for SCD in OSA patients was 1.41 (95% CI: 0.91-2.16; p = 0.12), with high heterogeneity (I² = 79.3%). Subgroup analysis showed increased risk in untreated OSA (OR = 3.87; 95% CI: 1.09-13.81; p = 0.04), but not in those receiving CPAP. Adjusted estimates showed no significant association (aOR = 0.90; 95% CI: 0.17-1.98; p = 0.10), with high heterogeneity (I² = 95.9%). Sensitivity analyses indicated moderate result stability; however, potential publication bias was observed. CONCLUSION: Available evidence is insufficient to establish a definitive association between OSA and SCD. Some subgroup analyses suggest an elevated risk in untreated OSA, but overall findings are heterogeneous and limited by study design. TRIAL REGISTRATION: Not applicable.