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Review
. 2025 May 9;29(2):182.
doi: 10.1007/s11325-025-03348-6.

Effects of continuous positive airway pressure therapy on inflammatory markers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

Qianhong Zhu  1   2   3 , Qiuyi Luo  1   2 , Zhichen Wang  1   2 , Senlin Chen  1   2 , Gengzhao Chen  1   2 , Saie Huang  4   5   6   7
Affiliations
Review

Effects of continuous positive airway pressure therapy on inflammatory markers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

Qianhong Zhu et al. Sleep Breath. .

Abstract

Objective: In this meta-analysis, we provide the findings of randomized controlled trials on the levels of inflammatory markers in patients with obstructive sleep apnea (OSA) receiving continuous positive airway pressure (CPAP).

Methods: Literature published in the PubMed, Web of Science, Embase and Cochrane databases up to May 21, 2024, was comprehensively searched, and inclusion and exclusion criteria were developed. Pooled estimates of CPAP therapy were analyzed via the standardized mean difference (SMD). This meta-analysis follows the PRISMA 2020 guidelines and is registered with PROSPERO (ID CRD42024548588).

Results: A total of 15 studies were included, each reporting data on one or more inflammatory markers, as follows: 10 studies on C-reactive protein (CRP), 12 studies on interleukin-6 (IL-6), 3 studies on interleukin-8 (IL-8), and 9 studies on tumor necrosis factor-α (TNF-α). The results revealed that the SMDs (95% confidence intervals [CIs]) for CRP, IL-6, IL-8 and TNF-α levels before and after CPAP treatment were 0.88 (95% CI 0.28-1.48), 0.58 (95% CI 0.12-1.05), 0.20 (95% CI 0.39-0.80) and 0.17 (95% CI 0.05-0.29), separately.

Conclusion: CPAP therapy used for a certain duration can lower CRP, IL-6 and TNF-α levels in OSA patients, and there are substantial differences observed in the various inflammatory indicators. To confirm the usefulness of these biomarkers in evaluating CPAP therapy for cardiovascular risk reduction among OSA patients, more randomized controlled trials (RCTs) have to be carried out in the future.

Keywords: Continuous positive airway pressure; Inflammatory markers; Meta-analysis; Obstructive sleep apnea.

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Conflict of interest statement

Declarations. Ethical approval: Ethical permission was not sought for this meta-analysis, as only pooled data from previously permitted individual studies were included. Informed consent: Every individual participant in the earlier research gave their informed permission. Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram illustrating the studies included and excluded stud in this meta-analysis
Fig. 2
Fig. 2
Comparing C-reactive protein levels in the 10 included studies before and after CPAP therapy. Abbreviations: SMD, standardized mean difference; CI, confidence interval
Fig. 3
Fig. 3
Comparing IL-6 levels in the 12 included studies before and after CPAP therapy. Abbreviations: SMD, standardized mean difference; CI, confidence interval
Fig. 4
Fig. 4
Comparing IL-8 levels in the 3 included studies before and after CPAP therapy. Abbreviations: SMD, standardized mean difference; CI, confidence interval
Fig. 5
Fig. 5
Comparing TNF-α levels in the 9 included studies before and after CPAP therapy. Abbreviations: SMD, standardized mean difference; CI, confidence interval
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