Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-analysis
Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-analysis
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DOI：
10.1002/lary.25032
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发表时间：
2015-05-01
期刊：
影响因子：
2.6
通讯作者：
Camacho, Macario
中科院分区：
文献类型：
--
作者：
Certal, Victor F.;Zaghi, Soroush;Camacho, Macario
目的/假设阻塞性睡眠呼吸暂停（OSA）患者对持续气道正压通气治疗的依从性差，对该治疗的有效性产生不利影响。本研究旨在系统地回顾关于舌下神经刺激作为治疗OSA的替代疗法的有效性和安全性的证据。数据来源Scopus，PubMed和科克伦图书馆数据库进行了检索方法纳入了评估舌下神经刺激治疗成人OSA的疗效的研究，其结果为呼吸暂停低通气指数（AHI），氧去饱和指数（ODI）和对日间嗜睡的影响（埃普沃思嗜睡量表[ESS]）。异质性和亚组analysispered.ResultsSix前瞻性研究200例患者被列入本次审查。12个月时，合并固定效应分析显示AHI、ODI和ESS的平均差异分别为-17.51（95% CI：-20.69至-14.34）、-13.73（95% CI：-16.87至-10.58）和-4.42（95% CI：-5.39至-3.44），具有统计学显著性降低。在3个月和6个月时观察到类似的显著降低。总体而言，AHI降低了50%至57%，ODI降低了48%至52%。尽管使用不同的舌下神经刺激器在每个亚组分析中，没有显着的异质性，发现在任何比较，建议等效的疗效，无论系统using.ConclusionsThis审查表明，舌下神经刺激治疗可以考虑在选定的OSA患者谁失败的药物治疗。需要进一步研究将舌下神经刺激与传统疗法进行比较，以明确评估结果。证据等级NA喉镜，125：1254-1264，2015
Objectives/HypothesisPoor adherence to continuous positive airway pressure treatment in obstructive sleep apnea (OSA) adversely affects the effectiveness of this therapy. This study aimed to systematically review the evidence regarding the efficacy and safety of hypoglossal nerve stimulation as an alternative therapy in the treatment of OSA.Data SourcesScopus, PubMed, and Cochrane Library databases were searched (updated through September 5, 2014).MethodsStudies were included that evaluated the efficacy of hypoglossal nerve stimulation to treat OSA in adults with outcomes for apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and effect on daytime sleepiness (Epworth Sleepiness Scale [ESS]). Tests for heterogeneity and subgroup analysis were performed.ResultsSix prospective studies with 200 patients were included in this review. At 12 months, the pooled fixed effects analysis demonstrated statistically significant reductions in AHI, ODI, and ESS mean difference of -17.51 (95% CI: -20.69 to -14.34); -13.73 (95% CI: -16.87 to -10.58), and -4.42 (95% CI: -5.39 to -3.44), respectively. Similar significant reductions were observed at 3 and 6 months. Overall, the AHI was reduced between 50% and 57%, and the ODI was reduced between 48% and 52%. Despite using different hypoglossal nerve stimulators in each subgroup analysis, no significant heterogeneity was found in any of the comparisons, suggesting equivalent efficacy regardless of the system in use.ConclusionsThis review reveals that hypoglossal nerve stimulation therapy may be considered in selected patients with OSA who fail medical treatment. Further studies comparing hypoglossal nerve stimulation with conventional therapies are needed to definitively evaluate outcomes.Level of EvidenceNA Laryngoscope, 125:1254-1264, 2015