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This systematic review and meta-analysis evaluated the diagnostic accuracy of peak expiratory flow rate (PEFR), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) for identifying RS in older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eight databases were systematically searched for studies involving adults aged \u226560\u00a0years. Risk of bias was assessed using QUADAS-2. Test-specific and overall pooled sensitivity and specificity were calculated for PEFR, MIP, and MEP according to the operational definitions adopted by the primary studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven studies comprising 2,466 participants were included (mean age range, 70.2\u201380.6\u00a0years). Overall pooled sensitivity was 0.614 (95% CI 0.453\u20130.753) and specificity was 0.726 (95% CI 0.443\u20130.898), with substantial heterogeneity (bivariate I\n                      <jats:sup>2<\/jats:sup>\n                      =0.929). Test-specific analyses showed distinct profiles: MEP-based approaches had relatively higher sensitivity and lower heterogeneity, MIP-based approaches had comparatively higher specificity, and PEFR-based approaches showed lower and more variable diagnostic performance. Meta-regression found no statistically detectable differences by sex or sarcopenia diagnostic criteria; however, these analyses were exploratory and underpowered.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Respiratory muscle-related measures show variable diagnostic performance for identifying RS. Current evidence is insufficient to establish the superiority of any single test or recommend a clinical reference standard. Prospective multicenter studies using standardized criteria and diverse populations, together with international consensus on RS definition, are needed to support future clinical recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration Number<\/jats:title>\n                    <jats:p>PROSPERO\u2014CRD42023494910.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s41999-026-01619-3","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:03:57Z","timestamp":1791997437000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic uncertainty in respiratory sarcopenia: accuracy of available tests and clinical implications: a systematic review and meta-analysis"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8710-9349","authenticated-orcid":false,"given":"Deivd","family":"Siqueira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3538-5687","authenticated-orcid":false,"given":"Helga","family":"Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7906-2981","authenticated-orcid":false,"given":"Harrison","family":"Euller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8806-8151","authenticated-orcid":false,"given":"Daiara","family":"Xavier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0643-8797","authenticated-orcid":false,"given":"Renata","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7509-8853","authenticated-orcid":false,"given":"Juliana Fernandes","family":"de Souza Barbosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3079-8300","authenticated-orcid":false,"given":"Shirley Lima","family":"Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8805-6815","authenticated-orcid":false,"given":"Daniella Cunha","family":"Brand\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1966-3352","authenticated-orcid":false,"given":"Diego","family":"Dantas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9430-4395","authenticated-orcid":false,"given":"Armele Dornelas","family":"de Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"1","key":"1619_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","unstructured":"Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. 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This systematic review and meta-analysis used data from previously published studies and did not involve direct recruitment of participants or collection of identifiable individual-level data; therefore, informed consent was not required.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}