Methods Search Strategy and Study Selection

Cardiovascular disease is the leading cause of death in the United States. Soaring rates of obesity correlate with an increasing incidence of obstructive sleep apnea (OSA), a recently hypothesized risk factor for ischemic heart disease (IHD) and ischemic stroke. Whether OSA independently increases their incidences, or whether this relationship is con-founded by this population’s prevalent cardiovascular risk fac-tors, remains debated. Although multiple studies have sought to identify whether OSA independently increases cardiovascular risk, their vari-able methodologies and results have hindered definitive conclusions. Furthermore, no meta-analysis of prospective studies has hitherto been performed. In light of OSA’s increas-ing prevalence and treatability plus the recent US Million Hearts campaign to prevent 1 million heart attacks and strokes in the next 5 years,1 we aimed to perform a systematic review and meta-analysis to identify whether OSA independently increases the risk of incident IHD, ischemic stroke, and car-diovascular mortality