Spatiotemporal Trends in the Prevalence of Obstructive Sleep Apnoea Across China: A Multilevel Meta-Analysis Incorporating Geographic and Demographic Stratification (2000-2024)

Yuqi Niu, Shanwen Sun, Yali Wang, Linlin Chen, Yefan Shao, Xiaochun Zhang Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of ChinaCorrespondence: Xiaochun Zhang, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang, Liaoning, People’s Republic of China, Tel +86 13898824248, Email [email protected]: China bears the highest global burden of obstructive sleep apnea (OSA), yet its spatiotemporal and occupational patterns remain unclear. We quantified OSA prevalence across Chinese subpopulations, focusing on geographic disparities, temporal trends, and occupational risks.Methods: Following PRISMA guidelines, we systematically searched six databases (2000– 2024) for population-based OSA studies using polysomnography or validated portable monitoring. Two researchers independently screened studies with third-party adjudication of discrepancies. Risk of bias was assessed using Joanna Briggs Institute criteria. Random-effects models pooled prevalence estimates; meta-regression identified heterogeneity contributors. OSA diagnosis followed 2012 AASM criteria (AHI ≥ 5; pediatric studies: OAHI ≥ 1.5).Results: From 62 studies (N=178,049), pooled OSA prevalence was 11.8% (95% CI:10.1– 13.4%), rising from 8.1% (2000– 2005) to 26.9% (2021– 2024). Prevalence was higher in males vs females (11.1% vs 6.0%, P< 0.001), with marked geographic disparities: Northwest China had the highest prevalence (17.8%, 16.3– 19.3%) versus Southwest (6.9%, 3.7– 10.9%). Drivers exhibited the highest occupational risk (15.3%). Low-quality studies overestimated prevalence (15.0% vs 7.6– 10.2% in higher-quality studies), and two-step sampling yielded higher estimates than single-risk-group designs (13.6% vs 7.4%, P< 0.001). Meta-regression identified survey period (β=0.036, P=0.025), male sex (β=− 0.062, P=0.047), geographic area (β=0.268, P=0.035), occupation (β=0.254, P=0.047), and sampling strategy (β=− 0.029, P=0.012) as key predictors of heterogeneity.Conclusion: OSA prevalence in China has accelerated significantly. Standardized screening is urgently needed for aging populations, high-risk occupations (particularly drivers), and underserved regions. Policy priorities should address rural diagnostic inequities and integrate OSA surveillance into public health programs. Methodological harmonization is critical for tracking OSA’s evolving burden.Keywords: obstructive sleep apnoea, OSA, prevalence, China, subgroup analysis, meta-analysis