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Impact of Positive Airway Pressure Therapy on Pulmonary Arterial Pressures in Sleep Apnoea and O

Systematic review and meta-analysis evaluating how positive airway pressure therapy affects pulmonary arterial pressures in obstructive sleep apnoea and obesity hypoventilation syn

GIST

This systematic review and meta-analysis assessed whether positive airway pressure (PAP) therapy lowers pulmonary arterial pressures (PAP) in patients with obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). The authors included 23 studies (20 observational, 3 randomized trials) totaling 733 participants, most with severe OSA; four studies involved OHS with concomitant OSA. The primary outcome was the post-PAP change in pulmonary arterial pressures, with separate analyses for pulmonary arterial systolic pressure (PASP) and mean pulmonary arterial pressure (mPAP). Across studies, PAP therapy was associated with a mean reduction in PAP of 5.96 mmHg (95% CI 3.20–8.73). Heterogeneity was noted (I2 >85%), reflecting differences in study design, patient populations, and methodologies. Sensitivity analyses suggested a larger effect in patients with baseline pulmonary hypertension. However, the certainty of evidence was described as low, warranting cautious interpretation. The findings indicate PAP therapy can reduce pulmonary arterial pressures in predominantly severe OSA or OHS, but applicability to milder disease is uncertain due to limited and variable data.

Clinical Editorial

Pulmonary Pressure Response to PAP in OSA and OHS: Study Landscape and Magnitude Study scope and design: - A systematic review with random-effects meta-analysis synthesized studies reporting pulmonary arterial pressures before and after positive airway pressure (PAP) therapy in adults with obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). - Eligible designs included observational studies and randomized controlled trials. The work followed PRISMA guidelines and was registered (PROSPERO: CRD42024595312). - Primary outcome: change in post-PAP pulmonary arterial pressures, with separate assessments for pulmonary arterial systolic pressure (PASP) and mean pulmonary arterial pressure (mPAP). Sensitivity analyses explored effects in cohorts with only OSA or OHS. Study characteristics and populations: - 23 studies were included, comprising 733 participants. - OSA-only: 19 studies (n = 518). - OHS with coexisting OSA: 4 studies (n = 215). - The majority of participants had severe OSA; details on baseline PH status varied by study. Main findings on PAP effects: - Across analyses, PAP therapy was associated with a reduction in pulmonary arterial pressures. - The pooled estimate for change demonstrated a mean decline of approximately 5.96 mmHg in PASP/mPAP, with a 95% confidence interval around 3.20 to 8.73 mmHg. - Heterogeneity was substantial (I-squared reported >85%), indicating variability in study design, patient characteristics, and measurement approaches. - The results indicated a more pronounced reduction in individuals with preexisting pulmonary hypertension. Context and interpretation: - Reductions in pulmonary arterial pressures were observed in all included groups, but the authors caution about applying these results to patients with milder OSA given the predominant severe OSA/OHS populations and study limitations. - The certainty of evidence was characterized as low, implying limited confidence in the estimated effect size and applicability across diverse clinical settings. Limitations and practical relevance: - Included studies varied in exposure definitions, PAP modalities, diagnostic criteria for PH, and follow-up durations. - The high heterogeneity and predominance of observational data limit causal inference and generalizability.

Original source: http://erj.ersjournals.com/cgi/content/short/67/4/2501037?rss=1