Background: A particularly high burden of sleep apnoea is reported in patients treated with cardiac implants suchas pacemakers and defibrillators. Sleep apnoea diagnosis remains a complex procedure mainly based on sleepand respiratory indices captured by polysomnography (PSG) or respiratory polygraphy (PG).Aim: We aimed to evaluate the performance of implantable cardiac devices for sleep apnoea diagnosis comparedto reference methods.Method: Systematic structured literature searches were performed in PubMed, Embase and.Cochrane Library was performed to identify relevant studies. Quantitative characteristics of the studies weresummarized and a qualitative synthesis was performed by a randomized bivariate meta-analysis and completedby pre-specified sensitivity analyses for different implant types and brands.Results: 16 studies involving 999 patients met inclusion criteria and were included in the meta-analysis. Themajority of patients were men, of mean age of 64 ± 4.6 years. Sensitivity of cardiac implants for sleep apnoeadiagnosis ranged from 60 to 100%, specificity from 50 to 100% with a prevalence of sleep apnoea varying from22 to 91%.For an apnoea-hypopnoea index threshold ≥30 events/h during polysomnography (corresponding to severe sleepapnoea), the overall performance of the implants was relevant with a sensitivity of 78% and a specificity of 79%.Subgroup analyses on implant type and brand provided no additional information owing to the small number ofstudies.Conclusion: The respiratory disturbance index provided by cardiac implants is clinically relevant and mightimprove access to sleep apnoea diagnosis in at-risk cardiovascular populations.PROSPERO Registration number: CRD42020181656