OBJECTIVE: To investigate the prevalence and clinical characteristics of sleep apnea (SA) in patients with hypertrophic cardiomyopathy (HCM). METHODS: Eligible studies were screened and selected from four databases. The pooled prevalence of SA in HCM was calculated and presented as proportion with 95% confidence intervals (CI). Comparison of clinical characteristics between HCM patients with or without SA was then assessed and presented as mean difference (MD) or odds ratio (OR) with 95%CI. Sensitivity analyses, subgroup analyses and meta-regression were then applied for heterogeneity assessment. RESULTS: Eight studies with 3,922 HCM patients was included, revealing an SA prevalence of 53% (95% CI 39%, 67%). HCM patients with SA were associated with older age (MD 8.91, 95% CI 7.28, 10.54), male (OR 1.59, 95%CI 1.30, 1.95). elevated body mass index (MD 2.59, 95%CI 1.36, 3.81), smoking (OR 1.86, 95%CI 1.39, 2.49), hypertension (OR 2.54, 95%CI 2.06, 3.14), diabetes (OR 2.03, 95%CI 1.31, 3.13) and atrial fibrillation (OR 1.96, 95%CI 1.51, 2.54). Echocardiographic findings revealed that HCM with SA was associated with reduced interventricular septum thickness (MD -1.25, 95%CI -2.44, -0.06), increased left atrial diameter (MD 1.48, 95%CI 0.49, 2.47) and left ventricular end-diastolic diameter (MD 2.81, 95%CI 1.99, 3.62). Additionally, HCM patients with SA showed increased application of hypertensive drugs, and application of calcium channel blockers was identified as source of heterogeneity in meta-regression. CONCLUSION: SA is highly prevalent in HCM, and HCM patients with comorbid SA exhibit distinct baseline characteristics, cardiac structure and drug application.