Context:

A synthesis of 23 studies including 733 patients with severe obstructive sleep apnea or obesity hypoventilation syndrome found that positive airway pressure therapy modestly lowers pulmonary arterial pressures, with a larger effect in those who already have pulmonary hypertension. Across all measurements, PAP therapy reduced mean pulmonary arterial pressure by about 6 mm Hg, and by roughly 11 mm Hg in patients with baseline pulmonary hypertension. The findings suggest routine assessment for pulmonary hypertension in severe OSA/OHS and ongoing monitoring of treatment response. However, most data come from observational studies with substantial heterogeneity, and several key patient-centered outcomes were not evaluated. The work signals a potential cardiovascular benefit of PAP, while highlighting the need for more rigorous trials and standardized reporting on adherence and nocturnal hypoxemia.

Dive Deeper:

• The analysis pooled 23 studies (20 observational, 3 randomized) covering 733 participants (average age ~56, 64% male), with 518 having OSA and 215 having OSA or OHS; post-treatment measurements were available for 718 participants.

• The primary outcome was the absolute change in pulmonary arterial pressure (mm Hg) after PAP therapy, assessed through multiple measurement methods for mean and systolic pressures.

• Overall, PAP therapy was associated with a mean reduction of 5.96 mm Hg in pulmonary arterial pressure (P < .0001).

• Among individuals with baseline pulmonary hypertension, the reduction was larger, averaging 11.41 mm Hg (P < .00001).

• Limitations include predominant reliance on observational studies, substantial heterogeneity, inconsistent reporting of PAP adherence and nocturnal hypoxemia, and the absence of patient-centered outcomes like symptoms, quality of life, functional capacity, or survival.

• The authors emphasize evaluating for pulmonary hypertension in severe OSA/OHS and tracking treatment response over time, pointing to potential cardiovascular benefits but calling for better-designed studies.

• Funding details were generally not reported; disclosures included editorial roles and financial relationships with several organizations, and the article notes use of editorial tools including AI in preparation.