Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea - Results of a meta-analysis
Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea - Results of a meta-analysis
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DOI：
10.1001/archinte.163.5.565
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发表时间：
2003-03-10
影响因子：
--
通讯作者：
Ayas, NT
中科院分区：
文献类型：
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作者：
Patel, SR;White, DP;Ayas, NT
背景：尽管持续气道正压通气 (CPAP) 已成为治疗阻塞性睡眠呼吸暂停 (OSA) 的护理标准，但 2 项系统评价对其实用性提出质疑。自这些评论发表以来，已经报道了几项随机对照试验。因此，我们进行了一项荟萃分析，以评估 CPAP 对主观和客观嗜睡的影响。方法：我们进行了彻底的文献检索，以识别所有已发表的 CPAP 对 OSA 患者的随机对照试验。使用随机效应模型进行荟萃分析：使用 Q 统计量评估统计异质性。结果：发现 12 项针对 OSA 患者进行 CPAP 试验符合我们的纳入标准。 11 项研究（706 名患者）报告了 Epworth 嗜睡量表评分。一项荟萃分析发现，CPAP 使 Epworth 嗜睡量表评分比安慰剂平均多降低 2.94 分 (P < .001)。研究之间的异质性 (Q(10) = 57.7，P < .001）无法用性别构成、平均年龄、平均体重指数或研究国家/地区的差异来解释。招募患有严重 OSA 加上嗜睡的受试者（平均呼吸暂停低通气指数，每小时大于或等于 30 次事件；平均 Epworth 嗜睡量表评分，大于或等于 11）的试验与其他研究相比，Epworth 嗜睡量表评分下降幅度更大（4.75 vs 1.10；P < .001）。 8 项试验（482 名受试者）报告了睡意的客观测量。持续气道正压通气比安慰剂使入睡潜伏期延长了 0.93 分钟 (P = .04)。结论：持续气道正压通气治疗显着改善了不同人群中 OSA 患者的主观和客观嗜睡测量。呼吸暂停和嗜睡较严重的患者似乎受益最多。
Background: Although continuous positive airway pressure (CPAP) has become the standard of care in the treatment of obstructive sleep apnea (OSA), 2 systematic reviews have questioned its utility. Since the publication of these reviews, several randomized controlled trials' have been reported. We, therefore, performed a meta-analysis to assess the effect of CPAP on subjective and objective sleepiness.Methods: We conducted a thorough literature search to identify all published randomized controlled trials of CPAP in patients with OSA. Meta-analyses were performed using a random-effects model: Statistical heterogeneity was assessed using the Q statistic.Results: Twelve trials of CPAP in patients with OSA meeting our inclusion criteria were found. The Epworth Sleepiness Scale score was reported in 11 studies (706 patients). A meta-analysis found that CPAP reduced the Epworth Sleepiness Scale score an average of 2.94 points more than placebo (P < .001). The heterogeneity (Q(10) = 57.7, P < .001) between studies could not be explained by differences in sex composition, mean age, mean body mass index, or country of study. Trials recruiting subjects with severe OSA plus sleepiness (mean apnea-hypopnea index, greater than or equal to 30 events per hour; and mean Epworth Sleepiness Scale score, greater than or equal to 11) had a greater decrease in the Epworth Sleepiness Scale score than the other studies (4.75 vs 1.10; P < .001). Objective measures of sleepiness were reported in 8 trials (482 subjects). Continuous positive airway pressure increased sleep onset latency by 0.93 minute (P = .04) more than placebo.Conclusions: Continuous positive airway pressure therapy significantly improves subjective and objective measures of sleepiness in patients with OSA across a diverse range of populations. Patients with more severe apnea and sleepiness seem to benefit the most.