Prevalence and characteristics of pulmonary hypertension in obstructive sleep apnea: a systematic review and meta-analysis

Sina Samieirad; Mahnaz Amini; Hanieh Raji; Fatemeh Hakkak Sadeghi; Nazanin Rasti; Amirhossien Derakhshan Doghaei; Emad Milani; Amirhossein Amiriani; Abolfazl Akbari; Shahabaddin Sorouri; Amir Baniasad

doi:10.1007/s11325-025-03543-5

Prevalence and characteristics of pulmonary hypertension in obstructive sleep apnea: a systematic review and meta-analysis

Sleep Breath. 2025 Nov 26;29(6):367. doi: 10.1007/s11325-025-03543-5.

Authors

Affiliations

¹ Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
² Department of Otolaryngology, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
³ Division of Sleep Medicine, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
⁴ Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
⁵ Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
⁶ Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Amirianiah971@mums.ac.ir.
⁷ Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Masteraa1379.ir@gmail.com.
⁸ Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Sorourish@mums.ac.ir.
⁹ Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

PMID: 41296161
DOI: 10.1007/s11325-025-03543-5

Abstract

Introduction: Pulmonary hypertension (PH) is a serious cardiovascular complication that can be associated with obstructive sleep apnea (OSA). We aimed to assess the prevalence and characteristics of PH in OSA patients.

Method: On May 13, 2025, a comprehensive literature search was performed to identify studies reporting the prevalence of PH in patients with OSA, or studies that compared OSA patients with and without PH. Data were pooled and subgroup-analyses, sensitivity-analyses and meta-regressions were performed based on apnea-hypopnea-index (AHI) thresholds, PH diagnostic methods, and study characteristics.

Results: Of 4,852 records, 53 included in the systematic-review and 46 in the quantitative-analysis. Across them, 1,190 OSA patients had PH (55.5%male) and 2,967 did not (64.5%male). The pooled prevalence of PH among OSA patients using AHI ≥ 5 criteria was 29.3% (95%CI[19.4-41.8], I²=94%). Sensitivity-analyses showed similar prevalence estimates when limited to studies using right-heart-catheterization (RHC)(29.6%) or those excluding small sample-sizes (< 50participants:30.9%) or retrospective designs (30.3%). Prevalence increased to 35.5% in studies using AHI ≥ 10 as the diagnostic-threshold. However, no significant difference in PH prevalence was found between mild-to-moderate and severe OSA (OR = 0.976[0.658-1.448], I²=47%). OSA patients with PH had significantly higher body-mass-index (BMI) (mean-difference (MD) = 3.432,P < 0.001), AHI (MD = 12.6,P < 0.001), ODI (standard-mean-difference (SMD) = 0.497), and T < 90% (SMD = 0.641), and lower meanSpO₂ (SMD = - 0.885) compared to those without PH. Age and sex were not different.

Conclusions: PH is relatively common among patients with OSA, with a pooled prevalence of approximately 29-31%. While OSA severity markers such as AHI and ODI were higher in PH patients, no consistent severity-dependent association with PH prevalence was observed.

Keywords: Meta-analysis; Obstructive sleep apnea (OSA); Prevalence; Pulmonary hypertension (PH).

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Female
Humans
Hypertension, Pulmonary* / diagnosis
Hypertension, Pulmonary* / epidemiology
Male
Prevalence
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / epidemiology