The safety and efficacy of nocturnal noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

The efficacy of nocturnal noninvasive positive pressure ventilation (NIPPV) in stable COPD remains controversial. This study evaluates the safety and clinical impact of nocturnal NIPPV compared with conventional therapy. A systematic search of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang was conducted from inception to July 26, 2025. Eligible randomized controlled trials (RCTs) published from 2015 onward and evaluating nocturnal NIPPV in stable COPD were included. Primary outcomes were arterial blood gases (PaCO2, PaO2, pH); secondary outcomes included pulmonary function, 6-min walking distance (6MWD), and health-related quality of life (HRQoL). Pooled effects were calculated using fixed- or random-effects models. PROSPERO Registration (CRD42024608837). Eight RCTs (736 patients) were analyzed. Nocturnal NIPPV significantly reduced PaCO2 and improved PaO2, with no significant change in pH. Regarding pulmonary function, FVC showed a non-significant trend toward improvement, and no significant differences were found for FEV1 or FEV1/FVC. Notably, 6MWD showed significant improvement in the NIPPV group. For HRQoL, significant gains were observed in the Severe Respiratory Insufficiency (SRI) questionnaire, and COPD Assessment Test (CAT) scores were significantly reduced. No serious adverse events were reported. Nocturnal NIPPV is a safe intervention for stable COPD, offering physiological and functional benefits by improving gas exchange and exercise capacity, while pulmonary-function effects were less consistent. However, its effects on spirometric airflow limitation and patient-reported outcomes should be interpreted cautiously because outcome instruments and the number of available studies differed. Further high-quality RCTs with standardized protocols are needed to define its optimal role in long-term management.