Aims. High prevalence of sleep apnea syndrome (SAS) has been reported in patients with diabetes. However, whether diabetic neuropathy (DN) contributes to this high prevalence is controversial. Our aim of this study is to compare the prevalence of SAS between patients with and without DN. Methods. Systematic literature searches were conducted for cross-sectional studies that reported the number of patients with DN and SAS using MEDLINE (from 1966 to Nov 5, 2012) and EMBASE (from 1974 to Nov 5, 2012). Odds ratios (ORs) of SAS related to DN were pooled with the Mantel-Haenszel method. Results. Data were obtained from 5 eligible studies (including 6 data sets, 880 participants, and 429 cases). Overall, the pooled OR of SAS in patients with DN compared with that in non-DN patients was significant (OR (95% CI), ？1.95 (1.03–3.70)). The pooled OR of SAS was 1.90 (0.97–3.71) in patients with type 2 diabetes. Excluding data on patients with type 1 diabetes, a higher OR was observed in younger patients (mean age <60 years) than in those ≥60 years among whom the OR remained significant (3.82; 95% CI, 2.24–6.51 and 1.17; 95% CI, 0.81–1.68). Conclusions. Current meta-analysis suggested the association of some elements of neuropathy with SAS in type 2 diabetes. Further investigations are needed to clarify whether the association is also true for patients with type 1 diabetes. 1. Introduction Sleep apnea syndrome (SAS) is characterized by nocturnal sleep restriction, sleep fragmentation, and intermittent hypoxia, resulting in poor sleep quality and daytime sleepiness [1, 2]. The prevalence of SAS, in particular obstructive sleep apnea, is dramatically increasing with the increased prevalence of obesity, which is the main cause of the upper airway obstruction typically observed as snoring while sleeping [3]. SAS not only causes a lower quality of life due to sleepiness but also has clinical consequences that include hypertension, diabetes, cardiovascular disease, and sudden death [1, 2, 4]. A recent meta-analysis indicated that obstructive sleep apnea is associated with an increased risk of future type 2 diabetes, [5] clearly suggesting that individuals with diabetes had a higher prevalence of SAS compared to those without diabetes. The higher prevalence of SAS is partially explained by the higher prevalence of obesity among individuals with diabetes compared with those without diabetes [6, 7]. Diabetic neuropathy (DN) [8, 9] has been suggested as another explanation for the presence of SAS because it is diabetes-specific [10]. However, epidemiological findings
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