Impact of positive airway pressure therapy on pulmonary arterial pressures in obstructive sleep apnoea or obesity hypoventilation syndrome: a systematic review and meta-analysis.

Our research question was: does treatment of OSA and obesity hypoventilation syndrome (OHS) with PAP therapy improve pulmonary arterial pressures?

我们的研究问题是：使用PAP治疗OSA和肥胖低通气综合征(OHS)是否能改善肺动脉压力？

Methods

A systematic reviewand random effects meta-analysiswas performed (PROSPERO: CRD42024595312).

进行了系统评价和随机效应的荟萃分析（PROSPERO: CRD42024595312）。

PubMed, Embase, Scopus, Web of Science, EBSCO, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov were searched using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.

使用PRISMA（系统评价和荟萃分析的首选报告项目）指南，对PubMed、Embase、Scopus、Web of Science、EBSCO、Cochrane中央控制试验登记处（CENTRAL）和ClinicalTrials.gov进行了搜索。

Studies reporting pulmonary arterial pressure in patients with OSA and OHS pre- and post-PAP therapy were included.

包括了报告了阻塞性睡眠呼吸暂停（OSA）和肥胖低通气综合征（OHS）患者在无创正压通气（PAP）治疗前后肺动脉压力的研究。

The primary outcome was post-PAP therapy change in pulmonary arterial pressures, with separate analyses on pulmonary arterial systolic pressure and mean pulmonary arterial pressure.

主要结果是无创正压通气（PAP）治疗后肺动脉压力的变化，包括对肺动脉收缩压和平均肺动脉压力的单独分析。

Sensitivity analysis was performed to assess the impact of PAP therapy in patients with only OSA or OHS.

进行了敏感性分析，以评估仅患有OSA或OHS的患者接受PAP治疗的影响。

Results

23 studies (20 observational and three randomised controlled trials) with 733 patients were included (19 with OSA (n=518) and four with OHS and concomitant OSA (n=215)).

共有23项研究（20项观察性研究和3项随机对照试验）纳入了733名患者（其中19项研究涉及OSA患者（n=518），4项研究涉及OHS和共存OSA患者（n=215））。

Most patients had severe OSA.

大多数患者患有重度阻塞性睡眠呼吸暂停（OSA）。

PAP therapy was associated with a mean reduction in pulmonary arterial pressure of 5.96 (95% CI 3.20-8.73) mmHg; p<0.0001.

经皮面气道正压（PAP）治疗与平均肺动脉压降低5.96（95%置信区间3.20-8.73）毫米汞柱相关；p<0.0001。

In patients with baseline PH (n=233), the reduction was 11.41 (95% CI 8.66-14.15) mmHg; p<0.00001.

在基线时存在肺动脉高压（PH）的患者中（n=233），血压降低了11.41（95% 置信区间 8.66-14.15）毫米汞柱；p<0.00001。

The beneficial effect of PAP therapy was similar in OSA and OHS.

持续气道正压（PAP）治疗对阻塞性睡眠呼吸暂停（OSA）和肥胖低通气综合征（OHS）患者的有益效果是相似的。

There was no sex difference in the impact of PAP therapy.

PAP治疗对性别影响没有差异。

Heterogeneity was high across studies (I2>85%), reflecting differences in study design, patient populations and methodologies.

研究间的异质性很高（I2>85%），反映了研究设计、患者人群和方法学的差异。

Conclusions

PAP therapy reduces pulmonary arterial pressures in patients with mostly severe OSA or OHS, with a more pronounced effect in those with baseline PH.

PAP治疗在患有重度OSA或OHS的患者中降低了肺动脉压力，对那些基线期就有PH的患者效果更为显著。

As such, our findings may not apply to patients with milder degrees of OSA.

因此，我们的发现可能不适用于患有轻度OSA的患者。

While reductions in pulmonary arterial pressures were observed in all groups, the low certainty necessitates cautious application of these findings in clinical practice.

尽管所有组都观察到肺动脉压力的降低，但确定性较低，这需要在临床实践中谨慎应用这些发现。