PAP Therapy Lowers Pulmonary Arterial Pressure in OSA and OHS, Meta-analysis Finds
Written By : Medha Baranwal
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2026-07-24 16:30 GMT | Update On 2026-07-24 16:30 GMT
USA: A systematic review and meta-analysis published in the European Respiratory Journal has found that positive airway pressure (PAP) therapy can significantly lower pulmonary arterial pressures in patients with obstructive sleep apnoea (OSA) or obesity hypoventilation syndrome (OHS), with the greatest benefits seen in those who already have pulmonary hypertension.
The study, led by Babak Mokhlesi from Rush University Medical Center in Chicago, evaluated existing evidence to determine whether PAP therapy improves pulmonary hemodynamics in these high-risk populations. OSA is characterised by repeated upper airway obstruction during sleep, leading to intermittent drops in oxygen levels and sleep disruption, while OHS involves obesity-related breathing impairment accompanied by elevated carbon dioxide levels during the day.
For this purpose, the researchers conducted a systematic review and meta-analysis of 23 studies, including 20 observational studies and three randomised controlled trials. The analysis included 733 patients with a mean age of nearly 56 years, of whom about two-thirds were men. Among them, 518 had OSA, while 215 had either OSA or OHS. Pulmonary arterial pressure measurements before and after PAP therapy were available for 718 participants.
The primary outcome assessed was the change in pulmonary arterial pressure following treatment.
Key Findings:
- PAP therapy was associated with a significant mean reduction of 5.96 mm Hg in pulmonary arterial pressure across both systolic and mean measurements.
- Among patients with pre-existing pulmonary hypertension, the reduction was greater, reaching 11.41 mm Hg.
- The reduction in pulmonary arterial pressure indicates a clinically meaningful improvement.
- The beneficial effects of PAP therapy were consistent in patients with obstructive sleep apnoea and obesity hypoventilation syndrome.
- No significant differences were observed in treatment response between males and females.
- Findings suggest PAP therapy may help reduce pulmonary vascular burden in patients with sleep-disordered breathing, particularly in severe cases.
The authors stress the need to screen patients with severe OSA or OHS for pulmonary hypertension and to monitor response to PAP therapy, as timely treatment may improve cardiopulmonary outcomes.
However, limitations include reliance on largely observational studies, high variability in the data, and inconsistent reporting of PAP adherence and nocturnal hypoxemia. The analysis also lacked patient-centred outcomes such as symptoms, quality of life, and survival.
Overall, PAP therapy appears to significantly reduce pulmonary arterial pressures, particularly in patients with existing pulmonary hypertension, though the evidence is of low certainty and should be interpreted cautiously, especially for milder cases.
Reference:
Mokhlesi B, Hache-Marliere M, Bjork ST, Jain D, Malhotra A, Masa JF, Labarca G. Impact of positive airway pressure therapy on pulmonary arterial pressures in obstructive sleep apnoea or obesity hypoventilation syndrome: a systematic review and meta-analysis. Eur Respir J. 2026 Apr 2;67(4):2501037. doi: 10.1183/13993003.01037-2025. PMID: 41309270; PMCID: PMC13044301.
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