What type of study is this?

This is a Systematic Review study (also classified as: Meta-Analysis).

September 29, 2025

Impact of positive airway pressure for chronic hypercapnic respiratory failure on sleep quality: a systematic review and meta-analysis.

Key Points

Sleep quality significantly improved with positive airway pressure therapy; results indicate a 5.87% increase in sleep efficiency.
The Pittsburgh Sleep Quality Index score decreased by an average of 2.51, highlighting better overall sleep quality.
The systematic review included 58 studies with over 2500 participants, focusing on the effects of positive airway pressure on sleep.
The findings emphasize the importance of sleep quality improvements through positive airway pressure for better health outcomes.

Abstract

Positive airway pressure (PAP) including noninvasive ventilation or continuous PAP are standard of care in chronic hypercapnic respiratory failure (CHRF). PAP is applied during sleep so its impact on sleep quality and daytime sleepiness is relevant. This systematic review and meta-analysis investigated the effects of PAP for CHRF on sleep quality. Relevant studies were identified by a PubMed/Embase search up to October 2024. Eligible studies included PAP initiation and evaluation of sleep quality/sleepiness. Evaluated outcomes were sleep efficiency, Pittsburgh Sleep Quality Index (PSQI), Severe Respiratory Insufficiency sleep subscale (SRI-AS) and Epworth Sleepiness Scale (ESS). 58 studies were included (n=2511; mean age 59.1 years, 57% male) and the indication for PAP was obesity hypoventilation syndrome (n=1073), neuromuscular disease (NMD) (n=649), COPD (n=428) or other/mixed aetiologies (n=361). Overall improvements were +5.87% (95% CI 2.64-9.09) for sleep efficiency, -2.51 (95% CI -3.22--1.80) for PSQI, +10.75 (95% CI 6.11-15.40) for SRI-AS score and -4.96 (95% CI -5.96--3.97) for ESS score. Adherence to PAP was the only factor significantly associated with sleep efficiency improvement. ESS and PSQI improved to a greater extent in people with a higher body mass index, younger age and hypercapnia correction during PAP. ESS improvement was associated with sleep efficiency improvement. PSQI improved to a greater extent in females and those with NMD. PAP initiation was associated with clinically relevant objective and subjective sleep quality improvements. Given the health benefits of good sleep, the effect of sleep quality improvements during PAP on prognosis should be investigated.

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