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.
Pulmonary Pressure Response to PAP in OSA and OHS: Study Landscape and Magnitude
The work followed PRISMA guidelines and was registered (PROSPERO: CRD42024595312).
Sensitivity analyses explored effects in cohorts with only OSA or OHS.