A NEW systematic review and meta-analysis confirms that positive airway pressure (PAP) therapy is associated with a significant reduction in all-cause and cardiovascular mortality in patients with obstructive sleep apnoea (OSA), reinforcing its potential life-saving benefits.
Researchers conducted a comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials, reviewing records up to September 2024 without language or geographical restrictions. Randomised controlled trials (RCTs) and confounder-adjusted, non-randomised controlled studies assessing the incidence of mortality in adults with OSA treated with PAP were included, while studies focused solely on PAP adherence were excluded. Independent screening by three researchers ensured rigorous selection, and statistical analysis employed a linear random-effects model to estimate hazard ratios (HRs) and 95% CIs. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle–Ottawa Scale for non-randomised controlled studies.
Out of 5484 identified records, 30 studies met inclusion criteria, comprising 1,175,615 participants, with 77% male and 23% female, an average age of 59.5 years, and a mean follow-up of 5.1 years. PAP therapy was associated with a significantly reduced risk of all-cause mortality (HR: 0.63, 95% CI: 0.56–0.72; P<0.0001) and cardiovascular mortality (HR: 0.45, 95% CI: 0.29–0.72; P<0.0001). The magnitude of benefit increased with greater PAP use, supporting a dose-response relationship between adherence and improved outcomes. The overall risk of bias was considered low to moderate.
These findings reinforce the necessity of PAP therapy in OSA management and highlight the importance of patient education to improve treatment adherence. Enhanced awareness of its benefits in reducing OSA mortality may drive better compliance and ultimately improve long-term outcomes in affected individuals.
Reference
Benjafield AV et al. Positive airway pressure therapy and all‐cause and cardiovascular mortality in people with obstructive sleep apnoea: a systematic review and meta-analysis of randomised controlled trials and confounder-adjusted, non-randomised controlled studies. Lancet Respir Med. 2025;DOI:10.1016/S2213-2600(25)00002-5.
