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Review Article
Online Published: 24 Dec 2025
 


Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review

Anwar Khalid Mayouf Alruwaili, Esraa Seraj Omar Aljahdali, Shahad Fahad Algmaizi, Ammar Sami M. Halawani, Ghady Ateeq S. Aljumaydi, Abdullah Saad Almufleh, Amjad Hammad A. Alharbi, Abdullah Hassan Mohammed Albariqi, Basel Ali Alshaqaqeeq, Ali Mohammed Almatar.


Abstract
Obstructive sleep apnea (OSA) and pulmonary hypertension (PH) are serious cardiovascular conditions with plausible pathophysiological links, including chronic intermittent hypoxia and intrathoracic pressure swings. However, establishing OSA as an independent risk factor for PH, distinct from common confounders like obesity and left heart disease, remains a subject of debate. This systematic review aimed at synthesizing contemporary evidence to definitively assess whether OSA serves as an independent risk factor for PH. A systematic literature search was conducted following PRISMA 2020 guidelines across PubMed/MEDLINE, Embase, Web of Science, and Cochrane Library databases. Observational studies and trials investigating the OSA-PH relationship in adults were included. Eight studies were included, comprising retrospective cohorts and cross-sectional analyses. A key finding was that prolonged nocturnal hypoxemia (T90, time with SpO₂<90%) was the strongest independent predictor of increased mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance. The prevalence of PH in OSA patients was high, ranging from 15% to 65.4%. Critically, one study found that treating OSA was associated with significantly greater improvements in exercise capacity in PH patients, underscoring its role as a modifiable risk factor. The association was particularly strong in high-risk subgroups like patients with OSA-COPD overlap syndrome. This systematic review provided compelling evidence that OSA is an independent and modifiable risk factor for PH. The risk is driven significantly by the burden of nocturnal hypoxemia, independent of common comorbidities. These findings advocated proactive screening, diagnosis, and aggressive treatment of OSA in patients with or at risk for PH.

Key words: Obstructive sleep apnea, pulmonary hypertension, nocturnal hypoxemia, risk factor, pulmonary artery pressure, systematic review.


 
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How to Cite this Article
Pubmed Style

Alruwaili AKM, Aljahdali ESO, Algmaizi SF, Halawani ASM, Aljumaydi GAS, Almufleh AS, Alharbi AHA, Albariqi AHM, Alshaqaqeeq BA, Almatar AM. Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review. IJMDC. 2025; 9(12): 3291-3298. doi:10.24911/IJMDC.51-1763663467

Web Style

Alruwaili AKM, Aljahdali ESO, Algmaizi SF, Halawani ASM, Aljumaydi GAS, Almufleh AS, Alharbi AHA, Albariqi AHM, Alshaqaqeeq BA, Almatar AM. Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review. https://www.ijmdc.com/?mno=298264 [Access: January 16, 2026]. doi:10.24911/IJMDC.51-1763663467

AMA (American Medical Association) Style

Alruwaili AKM, Aljahdali ESO, Algmaizi SF, Halawani ASM, Aljumaydi GAS, Almufleh AS, Alharbi AHA, Albariqi AHM, Alshaqaqeeq BA, Almatar AM. Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review. IJMDC. 2025; 9(12): 3291-3298. doi:10.24911/IJMDC.51-1763663467


Vancouver/ICMJE Style

Alruwaili AKM, Aljahdali ESO, Algmaizi SF, Halawani ASM, Aljumaydi GAS, Almufleh AS, Alharbi AHA, Albariqi AHM, Alshaqaqeeq BA, Almatar AM. Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review. IJMDC. (2025), [cited January 16, 2026]; 9(12): 3291-3298. doi:10.24911/IJMDC.51-1763663467


Harvard Style

Alruwaili, A. K. M., Aljahdali, . E. S. O., Algmaizi, . S. F., Halawani, . A. S. M., Aljumaydi, . G. A. S., Almufleh, . A. S., Alharbi, . A. H. A., Albariqi, . A. H. M., Alshaqaqeeq, . B. A. & Almatar, . A. M. (2025) Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review. IJMDC, 9 (12), 3291-3298. doi:10.24911/IJMDC.51-1763663467


Turabian Style

Alruwaili, Anwar Khalid Mayouf, Esraa Seraj Omar Aljahdali, Shahad Fahad Algmaizi, Ammar Sami M. Halawani, Ghady Ateeq S. Aljumaydi, Abdullah Saad Almufleh, Amjad Hammad A. Alharbi, Abdullah Hassan Mohammed Albariqi, Basel Ali Alshaqaqeeq, and Ali Mohammed Almatar. 2025. Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review. International Journal of Medicine in Developing Countries, 9 (12), 3291-3298. doi:10.24911/IJMDC.51-1763663467


Chicago Style

Alruwaili, Anwar Khalid Mayouf, Esraa Seraj Omar Aljahdali, Shahad Fahad Algmaizi, Ammar Sami M. Halawani, Ghady Ateeq S. Aljumaydi, Abdullah Saad Almufleh, Amjad Hammad A. Alharbi, Abdullah Hassan Mohammed Albariqi, Basel Ali Alshaqaqeeq, and Ali Mohammed Almatar. "Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review." International Journal of Medicine in Developing Countries 9 (2025), 3291-3298. doi:10.24911/IJMDC.51-1763663467


MLA (The Modern Language Association) Style

Alruwaili, Anwar Khalid Mayouf, Esraa Seraj Omar Aljahdali, Shahad Fahad Algmaizi, Ammar Sami M. Halawani, Ghady Ateeq S. Aljumaydi, Abdullah Saad Almufleh, Amjad Hammad A. Alharbi, Abdullah Hassan Mohammed Albariqi, Basel Ali Alshaqaqeeq, and Ali Mohammed Almatar. "Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review." International Journal of Medicine in Developing Countries 9.12 (2025), 3291-3298. Print. doi:10.24911/IJMDC.51-1763663467


APA (American Psychological Association) Style

Alruwaili, A. K. M., Aljahdali, . E. S. O., Algmaizi, . S. F., Halawani, . A. S. M., Aljumaydi, . G. A. S., Almufleh, . A. S., Alharbi, . A. H. A., Albariqi, . A. H. M., Alshaqaqeeq, . B. A. & Almatar, . A. M. (2025) Obstructive sleep apnea as an independent risk factor for pulmonary hypertension: a systematic review. International Journal of Medicine in Developing Countries, 9 (12), 3291-3298. doi:10.24911/IJMDC.51-1763663467




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