Effect of different modes of positive airway pressure treatment on obesity hypoventilation syndrome: a systematic review and network meta-analysis

Objective: To perform a systematic review and network meta-analysis to provide comparative evidence and quantitative hierarchies of the effectiveness of positive airway pressure (PAP) treatment on obesity hypoventilation syndrome (OHS).Methods: We searched PubMed, Embase, and Cochrane Library databases for relevant articles about the treatment of OHS published from the time of database creation to February 2021. Two independent reviewers performed the study search and screening, quality assessment and data extraction. The network meta-analysis within the frequentist framework was performed using Stata 15.0. The outcomes included changes in arterial blood gases, sleep quality, and polysomnography parameters.Results: Ten articles were included in the study. The results of the network meta-analysis showed that PAP treatment could decrease the partial pressure of carbon dioxide, bicarbonate level, apnea-hypopnea index, Epworth sleepiness scale score, and percentage of light sleep, and increase the partial pressure of oxygen, oxygen saturation, and percentage of rapid eye movement sleep and deep sleep when compared with control group in OHS patients. In addition, the results of the derived hierarchy showed that BPAPAVAPS and BPAP-ST were the first two modes of PAP treatment that reduced the partial pressure of carbon dioxide and percentage of light sleep and improved the percentage of rapid eye movement sleep and deep sleep. However, there was no difference in the quality of life, total sleep time, and sleep effi-ciency between any mode of PAP treatment and the control group.Conclusions: PAP treatment is beneficial for OHS patients, and the modes of BPAP-AVAPS and BPAP-ST demonstrated the largest improvement in hypercapnia and objective sleep structure.0 2022 Elsevier B.V. All rights reserved.