Intern Med J. 2025 Jul 2. doi: 10.1111/imj.70137. Online ahead of print.
ABSTRACT
BACKGROUND: Patients with obstructive sleep apnoea (OSA) and/or obesity hypoventilation syndrome (OHS) are at increased risk of developing pulmonary hypertension (PH). The presence of PH is associated with a worse prognosis. The primary treatment for most patients with OSA/OHS is positive airway pressure (PAP). The aim of this study was to systematically review the effects of PAP therapy on pulmonary artery (PA) pressure in patients with OSA/OHS and PH.
AIMS: Does PAP therapy improve pulmonary artery pressure in patients with OSA/OHS and PH?
METHODS: Two independent investigators searched studies in MEDLINE, Embase and Cochrane Library. A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included studies involving adult OSA/OHS patients treated with CPAP/BPAP, with PA pressure ≥20 mmHg before treatment. Data synthesis utilised random-effects meta-analysis to estimate treatment effect.
RESULTS: The search identified 1373 studies, with eight meeting inclusion criteria. Baseline characteristics of patients with PH were a mean age of 53 years, 86% male, a mean apnoea-hypopnea index (AHI) of 64 events/h and a mean BMI of 33 kg/m2. Meta-analysis revealed a reduction in PA pressure after PAP therapy (mean difference -8.62 mmHg, 95% CI: 4.01-13.22, P < 0.001). However, there was considerable between-study heterogeneity (I2 = 97.5%).
CONCLUSION: This study indicates that PAP therapy reduces PA pressure in patients with OSA/OHS, indicating potential benefits in managing PH. Further research is warranted to elucidate optimal PAP therapy protocols and long-term outcomes.
PMID:40605318 | DOI:10.1111/imj.70137