Background <p>Obstructive Sleep Apnea (OSA) is a common yet often undiagnosed disorder with serious health consequences. Studies in Pakistan have reported highly variable prevalence rates, highlighting the need for a comprehensive assessment. This systematic review and meta-analysis aimed to estimate the pooled prevalence of OSA in Pakistan to inform healthcare policies.</p> Methods <p>This systematic review and meta-analysis was conducted following PRISMA guidelines, with a literature search in PakMediNet, Medline, Scopus, and Web of Science from 2000 to 2025. The methodological quality of the studies was assessed using the JBI tool. Data analysis was performed using STATA 17, and heterogeneity was evaluated with the I² index. Sensitivity analysis, subgroup analysis, and meta-regression were conducted to identify sources of heterogeneity. Publication bias was assessed using Egger’s test and a funnel plot, and if necessary, adjusted with the trim-and-fill method.</p> Results <p>The final analysis included 39 studies (46 reports) conducted between 2008 and 2024. The overall prevalence of sleep apnea in Pakistan was 35% (95% CI: 29–40), with significant variations across populations and diagnostic methods. The highest prevalence was observed in diabetic patients (56.8%, with 95% CI: 42.3–71.2) and in studies using polysomnography (50.8%, with 95% CI: 29-72.7). Regional differences were not statistically significant. Sensitivity analysis confirmed the robustness of findings, and although publication bias was detected, the trim-and-fill analysis indicated that its impact was negligible.</p> Conclusion <p>The findings indicate a high prevalence of sleep apnea in Pakistan, particularly among diabetic patients and studies using polysomnography. Given its potential health risks, targeted screening and early intervention strategies are essential to improve diagnosis and management.</p>