TOPLINE:

In patients with predominantly severe obstructive sleep apnea (OSA) or obesity hypoventilation syndrome (OHS), treatment with positive airway pressure (PAP) therapy was associated with clinically meaningful reductions in pulmonary arterial pressures, especially among those with established pulmonary hypertension.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 23 studies (20 observational studies and three randomized controlled trials) to examine whether PAP therapy alters mean and systolic pulmonary arterial pressures in patients with OSA or OHS, including those with preexisting pulmonary hypertension.
• Overall, 733 patients (mean age, 55.9 years; 64% male), including 518 with OSA and 215 with OSA or OHS, underwent PAP therapy; pretreatment and posttreatment pulmonary arterial pressure measurements were available for 718 patients.
• The primary outcome was the absolute change in pulmonary arterial pressure, measured in mm Hg, after PAP therapy.
• OSA is marked by repeated partial or complete upper airway collapse during sleep, causing intermittent hypoxemia, arousals, and large intrathoracic pressure swings; OHS was defined as obesity with sleep-disordered breathing plus daytime hypercapnia.

TAKEAWAY:

• Among all patients, use of PAP therapy was associated with a mean reduction of 5.96 mm Hg in pulmonary arterial pressure across all measurement methods, including mean and systolic pulmonary arterial pressures (P < .0001).
• Among patients with pulmonary hypertension at baseline, use of PAP therapy was associated with a mean reduction in pulmonary arterial pressure of 11.41 mm Hg (P < .00001).

IN PRACTICE:

“[Our] finding highlights the need for assessing patients with severe forms of OSA or OHS for PH [pulmonary hypertension] and assessing treatment response over time,” the authors of the study wrote.

SOURCE:

The study was led by Babak Mokhlesi, MD, MSc, Rush University Medical Center, Chicago. It was published online on April 2, 2026, in the European Respiratory Journal.

LIMITATIONS:

Most included studies were observational, producing substantial heterogeneity. Key variables — notably PAP adherence and objective measures of nocturnal hypoxemia — were reported inconsistently across studies. The analysis examined only changes in pulmonary arterial pressures and lacked patient-centered outcomes such as symptoms, quality of life, 6-minute walk distance, and survival.

DISCLOSURES:

No specific funding was reported for the study. One author reported holding an editorial role with the Journal of Clinical Sleep Medicine and receiving payment for legal expert testimony. Another reported receiving National Institutes of Health research funding; having paid relationships with LivaNova, Eli Lilly and Company, ZOLL, and Powell Mansfield; and being a co-founder of Clairyon.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.