The role of air quality and pollution in obstructive sleep apnea: insights from recent studies.

INTRODUCTION: Air pollution is an increasingly important environmental determinant of respiratory health and has emerging relevance for obstructive sleep apnea (OSA). Although obesity, aging, sex, craniofacial anatomy, and neuromuscular factors remain established contributors to OSA, ambient and indoor pollutants, together with climate-related and meteorological factors, may influence sleep-disordered breathing through multiple biological pathways. This review summarizes recent epidemiological and mechanistic evidence linking environmental exposures with OSA risk, symptoms, and severity. AREAS COVERED: This narrative review synthesizes evidence from PubMed and Web of Science (database inception through 30 June 2026) on the relationship between environmental exposures and OSA, including air pollution, indoor and outdoor pollutants, climate change, and meteorological factors. We summarize current epidemiological evidence linking environmental exposures with OSA risk, symptoms, and severity; evidence from vulnerable populations; and biological mechanisms involving upper-airway inflammation, oxidative stress, autonomic dysfunction, intermittent hypoxia, and metabolic dysregulation. EXPERT OPINION: Although current evidence is suggestive, it remains heterogeneous; future research should therefore incorporate standardized exposure assessment, objective sleep measurements, longitudinal and intervention designs, and mechanistic biomarkers. Recognition of environmental risk factors may support more comprehensive OSA prevention, risk stratification, counseling, and public health strategies.