Efficacy of continuous positive airway pressure on cardiac remodeling and ventricular function in obstructive sleep apnea: a systematic review and updated meta-analysis of speckle-tracking echocardiography

Nov 13, 2025Journal of hypertension

Continuous positive airway pressure may improve heart structure and pumping in obstructive sleep apnea

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Abstract

CPAP therapy significantly improved left ventricular function by -1.92% and right ventricular function by -1.88% in patients with obstructive sleep apnea.

Improvement in left ventricular global longitudinal strain (LV-GLS) and right ventricular global longitudinal strain (RV-GLS) was observed with CPAP treatment.
No significant changes were found in left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), left ventricular mass, pulmonary vascular resistance (PVR), or the E/e' ratio.
CPAP therapy significantly reduced pulmonary artery systolic pressure (PASP) by -5.23 mmHg and right atrial volume index by -3.96 ml/m².
Left atrial volume showed no significant change with CPAP therapy.
The findings indicate that CPAP may improve cardiac function and reduce right atrial volume in patients with obstructive sleep apnea.

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Obstructive sleep apnea (OSA) is associated with structural heart disease, with continuous positive airway pressure (CPAP) potentially improving cardiac remodeling. This meta-analysis provides an updated assessment of CPAP's effects on myocardial strain and remodeling in patients with OSA. A systematic review and meta-analysis of clinical studies evaluating CPAP's effects on speckle-tracking echocardiographic parameters in OSA patients was conducted. PubMed, Embase and Cochrane Central were searched. A random-effects model analyzed pooled data. Studies assessing right ventricular global longitudinal strain (RV-GLS) or left ventricular global longitudinal strain (LV-GLS) were included. Ten studies [one randomized controlled trial (RCT), nine observational] involving 385 patients treated with CPAP were analyzed. CPAP significantly improved left ventricular GLS -1.92% [-2.63 to -1.21] (MD [95% confidence interval]), P < 0.01; and right ventricular GLS -1.88% [-2.77 to -0.99], P < 0.01. No significant changes were observed in LVEF 0.77% [-0.65 to 2.18] P = 0.29; TAPSE 0.07 mm [-0.53 to 0.68] P = 0.81, I2 = 0%; LV mass [SMD -0.22; -0.56 to 0.12] P = 0.54, I2 = 0%; PVR -0.59 [-1.25 to 0.04] P = 0.08; or E/e' ratio -0.95 [-2.42 to 0.53], P = 0.21. CPAP significantly reduced PASP -5.23 mmHg [-8.54 to -1.92], P = 0.002, I2 = 64%; and right atrial volume index -3.96 ml/m 2 [-5.43 to -2.50], P < 0.001, with no significant change in left atrial volume [SMD -0.01; -0.35 to 0.32], P = 0.93. CPAP therapy improves both left and right ventricular function and reduces right atrial volume in patients with OSA. Further trials are needed to assess CPAP's long-term impact on myocardial strain and cardiac mechanics beyond conventional echocardiography.

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Efficacy of continuous positive airway pressure on cardiac remodeling and ventricular function in obstructive sleep apnea: a systematic review and updated meta-analysis of speckle-tracking echocardiography

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