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Review
. 2025 Oct 3:84:102168.
doi: 10.1016/j.smrv.2025.102168. Online ahead of print.

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

Pierre Tankéré  1 , Léa Razakamanantsoa  2 , Charles Khouri  3 , Maxime Patout  2 , Emeric Stauffer  4 , Sebastien Baillieul  5 , Thierry Petitjean  6 , Jean Louis Pépin  5 , Renaud Tamisier  5 , Laure Peter Derex  7
Affiliations
Free article
Review

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

Pierre Tankéré et al. Sleep Med Rev. .
Free article

Abstract

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).

Keywords: Chronic respiratory failure; Non-invasive ventilation; Polysomnography; Positive airway pressure; Rapid eye movement sleep; Sleep architecture; Slow-wave sleep.

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Conflict of interest statement

Competing interests - PT reports travel and congress grant from Asdia, Resmed, Linde and ALLP; grant support through his institution from “Agir pour les maladies chroniques” foundation. - JL Pépin reports income related to medical education from RESMED, SEFAM, Zoll-Respicardia, Eli Lilly, Idorsia, Pharmanovia and Bioprojet. - MP reports no support for the present manuscript. For other works he reports grants contracts consulting fees, honoraria for lectures, travel grants, participation on advisory board, stock and receipt of equipment from Resmed, Philips Respironics, Asten Santé, Kernel Biomedical, SOS Oxygen, Chiesi, Lowenstein, Bastide, Elivie, Antadir, Jazz Pharmaceutical, Fisher & Paykel, Orkyn Sanofi, GSK and Air Liquide Medical. - LPD reports receiving lecture fees from Bioprojet, Eisai, Zogenix and Roche; grant support through her institution from Asten Sante, Linde and Bioprojet; and travel grants from Bioprojet and VitalAire. - RT reports receiving consultant and lecture fees from ResMed, Inspire and Bioprojet; grant support through his institution from ResMed, Inspire, Agiradom and Bioprojet; and travel grants from Agiradom. - All other authors declare no competing interests related to this work.

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