Abstract

Background: Obstructive sleep apnea (OSA) is a frequent respiratory problem associated with sleep, and polycystic ovarian syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age. Although a thorough synthesis of current data is needed, emerging evidence points to a possible reciprocal link between these two illnesses.
Objective: To thoroughly compile and evaluate peer-reviewed research on the relationship between PCOS and OSA, focusing on prevalence, pathophysiological mechanisms, clinical characteristics, and health implications.
Methods: For articles published from 2021 to 2026, a thorough search of the literature was done using PubMed/MEDLINE, Scopus, and Web of Science. Studies reporting original data on PCOS and OSA diagnosis or outcomes were included. Twelve studies met the eligibility criteria, including cross-sectional studies, prospective cohorts, Mendelian randomization (MR) analyses, and one randomized controlled trial. Checklists from the Joanna Briggs Institute were used to measure quality.
Results: The prevalence of OSA in women with PCOS ranged from 27.7% to 40%, substantially higher than in non-PCOS controls. Bidirectional MR confirmed causal relationships between PCOS and OSA in European populations (OR 1.133-1.463) but not in East Asians. Key predictors included impaired fasting glucose (OR 29.19), elevated body mass index, neck circumference (AUC 0.842), and low sex hormone-binding globulin. During in vitro fertilization, PCOS individuals with OSA showed noticeably decreased clinical pregnancy and live birth rates, reduced anti-Müllerian hormone levels, and worse metabolic profiles. In one randomized study, continuous positive airway pressure treatment improved metabolic indices and pregnancy rates. High-risk OSA was linked to twice increased chances of anxiety (aOR 2.39) and thrice increased odds of moderate-to-severe depression (aOR 3.06).
Conclusion: OSA is far more common in women with PCOS, and there is evidence of a reciprocal causal link. Comorbid OSA has a negative impact on mental, metabolic, and reproductive consequences. When treating PCOS patients, especially those with obesity, infertility, or mood issues, clinicians should keep a high level of suspicion for OSA.

Key words: Keywords: Polycystic ovary syndrome; PCOS; Obstructive sleep apnea; OSA; Sleep-disordered breathing; Hyperandrogenism; Insulin resistance