Accuracy of Machine Learning Algorithms Based on Electroencephalogram in Sleep Apnea Detection: Systematic Review and Meta-Analysis.

Background: Sleep apnea (SA) is a serious sleep disorder, and its diagnostic gold standard, polysomnography, is costly and time-consuming. Electroencephalogram (EEG) signals, due to their direct correlation with neural activity and ease of extraction, represent a promising tool. Despite increasing research on machine learning (ML) and deep learning for EEG-based SA detection, model performance has not been consistently evaluated. Objective: This systematic review evaluated the accuracy of ML in detecting SA from EEG data and provided an evidence base for further clinical application and future research. Methods: Following the PRISMA-DTA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 expanded checklists, we systematically searched PubMed, Embase, Web of Science, Cochrane Library (CENTRAL), Scopus, IEEE Xplore, and ClinicalTrials.gov databases from inception to April 2026. Studies evaluating the value of ML algorithms for detecting SA based only on EEG data were included. The Quality Assessment of Diagnostic Accuracy Studies-2 and Prediction Model Risk of Bias Assessment Tool for Artificial Intelligence tools were used to assess the risk of bias in each study. Statistical analysis was performed using the mada and metafor packages in R (version 4.6.0; R Foundation for Statistical Computing) and the Meta-DiSc (version 1.4; Hospital Ramón y Cajal) software. We used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to evaluate the certainty of evidence. Results: A total of 27 retrospective studies were included. Segment-level analyses showed high diagnostic performance, with a pooled sensitivity of 0.90 (95% CI 0.85-0.94; 95% prediction interval 0.43-0.99) and specificity of 0.92 (95% CI 0.87-0.95; 95% prediction interval 0.46-0.99). The pooled area under the summary receiver operating characteristic curve was 0.95 (95% CI 0.92-0.99). Meta-regression identified EEG channel configuration, region, and validation strategy as significant sources of heterogeneity (P=.004, P=.003, and P=.046, respectively). Multichannel EEG, deep learning approaches, and hold-out validation strategies generally demonstrated better diagnostic performance. Only 2 studies evaluated patient-level diagnostic performance, which was summarized qualitatively. Conclusions: To our knowledge, this is the first systematic review and meta-analysis specifically focused on the diagnostic accuracy of EEG-based ML models in the detection of SA. This meta-analysis indicates that ML models based on EEG demonstrate good diagnostic accuracy in detecting SA at the segment level and show promise as tools for SA screening and clinical decision support. However, most current studies are retrospective segment-level analyses, which may overestimate the practical value of this technology in real-world clinical settings. To reliably integrate EEG-based ML models into clinical diagnostic workflows, further prospective studies incorporating full-night monitoring and patient-level validation are needed.