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

IF 10.4 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Review Pub Date : 2025-09-26 Print Date: 2025-07-01 DOI:10.1183/16000617.0090-2025

Pierre Tankéré, Léa Razakamanantsoa, Charles Khouri, Maxime Patout, Emeric Stauffer, Sebastien Baillieul, Thierry Petitjean, Jean Louis Pépin, Laure Peter Derex, Renaud Tamisier

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Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusion: 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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慢性高碳酸血症性呼吸衰竭患者气道正压治疗对睡眠质量的影响：一项系统综述和荟萃分析。

背景：气道正压通气（PAP）包括无创通气或持续PAP是慢性高碳酸血症性呼吸衰竭（CHRF）的标准治疗方法。PAP是在睡眠中应用的，所以它对睡眠质量和白天嗜睡的影响是相关的。本系统综述和荟萃分析调查了PAP治疗CHRF对睡眠质量的影响。方法：通过PubMed/Embase检索到2024年10月的相关研究。符合条件的研究包括PAP的启动和睡眠质量/嗜睡的评估。评估结果为睡眠效率、匹兹堡睡眠质量指数（PSQI）、严重呼吸功能不全睡眠分量表（SRI-AS）和Epworth嗜睡量表（ESS）。结果：纳入58项研究（n=2511，平均年龄59.1岁，57%为男性），PAP的适应症为肥胖低通气综合征（n=1073）、神经肌肉疾病（n=649）、慢性阻塞性肺病（n=428）或其他/混合病因（n=361）。睡眠效率的总体改善为+5.87% (95% CI 2.64-9.09)， PSQI的总体改善为-2.51 (95% CI -3.22- 1.80)， SRI-AS评分的总体改善为+10.75 (95% CI 6.11-15.40)， ESS评分的总体改善为-4.96 （95% CI -5.96- 3.97）。坚持PAP是唯一与睡眠效率改善显著相关的因素。体重指数高、年龄小、PAP期间高碳酸血症纠正的患者ESS和PSQI改善程度更大。ESS改善与睡眠效率改善相关。PSQI在女性和NMD患者中改善程度更大。结论：PAP启动与临床相关的客观和主观睡眠质量改善有关。鉴于良好的睡眠对健康的益处，应该研究PAP期间睡眠质量改善对预后的影响。

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来源期刊

European Respiratory Review Medicine-Pulmonary and Respiratory Medicine

CiteScore

14.40

自引率

1.30%

发文量

审稿时长

24 weeks

期刊介绍： The European Respiratory Review (ERR) is an open-access journal published by the European Respiratory Society (ERS), serving as a vital resource for respiratory professionals by delivering updates on medicine, science, and surgery in the field. ERR features state-of-the-art review articles, editorials, correspondence, and summaries of recent research findings and studies covering a wide range of topics including COPD, asthma, pulmonary hypertension, interstitial lung disease, lung cancer, tuberculosis, and pulmonary infections. Articles are published continuously and compiled into quarterly issues within a single annual volume.