Hyperbaric Oxygen Therapy and Its Physio-Mechanical Effects on Sleep Breathing Disorder: A Systematic Review

Hyperbaric oxygen therapy (HBOT), traditionally used for decompression sickness and chronic wounds, has recently attracted interest for its potential role in sleep breathing disorders (SBD). Because sleep is highly sensitive to oxygen homeostasis, altered oxygenation can significantly disrupt sleep architecture and efficiency.

This review examines emerging evidence on HBOT's effects in modulating sleep physiology and alleviating major SBD phenotypes, including obstructive sleep apnea (OSA), central sleep apnea (CSA), and high-altitude-related breathing disorders. HBOT may exert therapeutic benefits through several mechanisms-reducing inflammation and oxidative stress, reversing tissue hypoxia, improving pulmonary function and oxygenation, enhancing neurocognitive function, modulating arousal threshold and loop gain, and influencing brain regions involved in sleep regulation. These physiological pathways provide a rationale for considering HBOT as an adjunctive or alternative therapy, especially for patient's intolerance of conventional treatments. This systematic review aims to synthesize existing evidence on the effects of HBOT in SBD, particularly OSA, CSA, and altitude-related sleep disturbances.

Current studies offer promising but preliminary evidence supporting HBOT's role in selected SBD populations. However, heterogeneity in protocols, small sample sizes, and limited long-term follow-up constrain interpretation. Future multicenter trials should focus on optimizing treatment pressure, duration, and patient selection, while ensuring safety across vulnerable populations. Understanding the interactions among hyperoxia, neurophysiology, and sleep regulation could unlock novel therapeutic directions for refractory or comorbid SBD.