A systematic review of obstructive sleep apnea in Indigenous peoples worldwide.

STUDY OBJECTIVES: Emerging evidence indicates that Indigenous peoples experience disproportionately high rates of obstructive sleep apnea (OSA). This systematic review aimed to examine OSA prevalence, contributing factors, and intervention or treatment outcomes among Indigenous peoples worldwide. MATERIALS AND METHODS: We systematically searched PubMed, Embase, CINAHL, Cochrane CENTRAL, ATSI Health, Web of Science and PsycINFO (last searched June 30, 2025), and grey literature for original research involving Indigenous peoples (≥18 years) diagnosed with OSA via self-report or laboratory-based measures (e.g. polysomnography). Data extraction focused on study characteristics and key findings. Methodological quality was assessed using NIH tools, and cultural appropriateness was evaluated using the CREATE Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was conducted. RESULTS: From 599 records, 41 studies from six countries were included. OSA prevalence among Indigenous populations varied widely (community-based samples, 6.5%-69%; referred samples, 85%-95%; self-reported diagnosis, 1.2%-8.4%; hospital audit diagnoses, 0.8%-11.4%), with only one study reporting a robust population-based estimate (~6.5% among Māori). Severe cases predominated in referred samples. Factors associated with OSA included male sex, age, BMI, neck circumference, craniofacial and geographic factors, and symptoms such as snoring. Treatment evidence was limited to CPAP, with low adherence. CONCLUSIONS: Findings suggests that OSA is common among Indigenous peoples across diverse settings. However, prevalence estimates are heterogeneous and limited by differences in study design, sampling frame, and diagnostic approaches, with most evidence based on referred clinical samples. Improving awareness and culturally responsive screening and management may improve outcomes. Sleep health among Indigenous peoples warrants a higher priority in research, policy and practice. REGISTRATION: The protocol for this systematic review was registered with Prospero (CRD42024466932).