Pooled prevalence of sleep paralysis in South Asian countries: A systematic review and meta-analysis.

BACKGROUND: Sleep paralysis (SP) is a rapid eye movement parasomnia often accompanied by intense psychological distress and hallucinations. The epidemiological landscape within the South Asian nations remains highly variable and poorly synthesized, compounded by deep-seated cultural stigmas. This systematic review and meta-analysis aims to establish the pooled prevalence of SP within the South Asian region. METHODS: A systematic literature search of PubMed, IMSEAR, PsycNet, and Google Scholar was conducted through February 2026 (PROSPERO: CRD420261301875). Primary studies in English reporting SP prevalence in SAARC countries were included. Methodological quality was assessed via the Newcastle-Ottawa Scale (NOS). Publication bias was evaluated using Egger's test and corrected via the trim-and-fill method. A meta-analysis of pooled prevalence was conducted using a random-effects model. RESULTS: The final analysis incorporated 23 constituent studies involving 5520 participants, synthesizing empirical data across the full spectrum of available South Asian cohorts, including community, university, and clinical populations. While the unadjusted pooled prevalence of SP was found to be 29% (95% CI (18%, 43%)), statistical evaluation revealed significant publication bias (p < 0.05). Across student, general, and clinical populations, sleep paralysis prevalence remains comparable by population subtype (32%, 25%, and 25%, respectively). Substantial inter-study heterogeneity (I2 = 95.7%) was identified as systemic: small cohorts reported 39% prevalence versus 21% in large-scale studies, and studies using SP-specific questionnaires reported a 46% prevalence, compared to 7% in non-specific questionnaires. Additionally, pooling only methodologically rigorous "Low Risk" studies yielded a conservative prevalence of 17%. CONCLUSIONS: The pooled prevalence of sleep paralysis was identified as 29%, comparable even with population variance. Significant variance was observed, primarily attributed to the use of varied diagnostic tools and non-specific methodologies.