SYSTEMATIC REVIEW article
Front. Med.
Sec. Pulmonary Medicine
The Impact of Continuous Positive Airway Pressure Combined with Lifestyle Intervention on Patients with Obstructive Sleep Apnea: A Multilevel Meta-Analysis
Provisionally accepted
- 1Capital University of Physical Education and Sports, Beijing, China
- 2Fujian Normal University, Fuzhou, China
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Background: Obstructive Sleep Apnea (OSA) is commonly managed with Continuous Positive Airway Pressure (CPAP), yet low adherence and insufficient metabolic improvements limit its effectiveness. Objective: This study aimed to systematically assess the effect of CPAP combined with lifestyle interventions on OSA severity, as measured by the Apnea-Hypopnea Index (AHI), and to explore potential moderators. Methods: This systematic review and meta-analysis followed the PRISMA 2020 guidelines. We identified randomized controlled trials (RCTs) in PubMed, Web of Science, the Cochrane Library, and Embase. Effect sizes were reported as mean differences (MD). Data were synthesized using multilevel random-effects models. Statistical heterogeneity was assessed with the I² statistic and Cochran's Q test. To identify potential moderators, we conducted sensitivity analyses, publication bias assessment, subgroup analyses, and meta-regression. The reliability of the evidence for each outcome was rigorously assessed using the GRADE framework. Results: Fourteen RCTs involving 1623 patients were included. CPAP combined with lifestyle interventions significantly reduced AHI (MD = -9.99, 95% CI: -14.55 to -5.44, P < 0.001, GRADE: Moderate). Subgroup analyses showed greater benefits with multicomponent lifestyle interventions (integrating diet, exercise, and behavioral strategies) (MD = -11.99, P < 0.001, GRADE: Moderate), intervention duration < 12 weeks (MD = -19.29, P < 0.001, GRADE: Low), moderate-to-severe OSA (MD = -11.55, P < 0.001, GRADE: Moderate), and BMI reduction of ≥ 5 kg/m² (MD = -23.39, P < 0.001, GRADE: Low). Meta-regression analyses showed that most prespecified moderators were not statistically significant, whereas increasing age was associated with greater reductions in AHI (β = −1.12, P = 0.024). Conclusions: Moderate-quality evidence indicates that CPAP combined with lifestyle interventions improves AHI in patients with OSA, particularly those with moderate-to-severe OSA, obesity, or receiving multi-component lifestyle interventions. The evidence is limited by high heterogeneity and risk of bias.
Keywords: apnea-hypopnea index, Continuous Positive Airway Pressure, lifestyle intervention, Multilevel meta-analysis, obstructive sleep apnea
Received: 18 Nov 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Yang, Qin, Lan, Liu, Zhu, Yao, Wang and Yi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zheng Yi
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