Prevalence and characteristics of pulmonary hypertension in obstructive sleep apnea: a systematic review and...

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.

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.

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.

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.