Positive airway pressure therapies improve sleep architecture in patients with chronic hypercapnic respiratory failure: A systematic review and meta-analysis.

Positive airway pressure therapies (PAP) are the standard of care for chronic hypercapnic respiratory failure (CHRF), and include continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) for obesity hypoventilation syndrome (OHS), and NIV for chronic obstructive pulmonary disease (COPD) and neuromuscular disease (NMD). The effects of PAP on sleep reflect a balance between correcting CHRF-induced sleep disturbances and the potential for therapy itself to disrupt sleep. Given the critical role of sleep in overall health, there are relevant concerns about the effects of PAP usage on sleep architecture. We performed a systematic review and meta-analysis of polysomnographic parameters, using a random-effects model for quantitative analyses. Forty studies were included (n = 1099; 438 OHS, 350 NMD, 175 COPD, 136 unspecified CHRF; 58 % male, age 56.6 ± 8.9 years, body mass index 36.5 ± 11.3 kg/m2, arterial carbon dioxide pressure 51.8 ± 5.0 mmHg). Significant improvements (estimate [confidence interval]) in sleep efficiency (+6.30 [3.00, 9.60]%), slow-wave sleep (+4.74 [3.08, 6.41]%), rapid-eye-movement sleep (+4.39 [2.84, 5.94]%), arousal index (-12.97 [-19.65, -6.28]/h), and apnea-hypopnea index (-15.13 [-22.34, -7.92]/h) were seen during PAP. Overall, PAP improved sleep architecture in CHRF. The prognostic significance of these changes warrants further investigation. TRIAL REGISTRATION: PROSPERO (CRD42023495516).