Treatment for sleep apnea by continuous positive airway pressure improves levels of inflammatory markers - a meta-analysis.
Treatment for sleep apnea by continuous positive airway pressure improves levels of inflammatory markers - a meta-analysis.
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DOI：
10.1186/1476-9255-10-13
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Bawaadam H
中科院分区：
文献类型：
--
作者：
Baessler A;Nadeem R;Harvey M;Madbouly E;Younus A;Sajid H;Naseem J;Asif A;Bawaadam H
阻塞性睡眠呼吸暂停（OSA）与冠状动脉疾病（CAD）相关。与OSA相关的间歇性缺氧增加交感神经活性，并可能导致全身炎症，这可能有助于OSA患者的CAD。持续气道正压通气（CPAP）治疗已被证明可以改变炎症标志物的水平。我们通过系统的荟萃分析对已发表研究的数据进行了分析。评估通过CPAP治疗睡眠呼吸暂停是否会影响炎症标志物的水平。PubMed、Embase和科克伦图书馆。研究合格性标准全文成人人类受试者的英文研究，说明CPAP治疗前后至少一种炎症标志物的值。我们将OSA定义为呼吸暂停低通气指数（AHI）≥ 5/h，以平均值和标准差或中位数及范围报告。成年人人类CPAP治疗OSA共审查了3835项研究以供纳入，同时汇总了23项研究以供分析。共有14项研究（771例患者）汇总了C反应蛋白（CRP）; 9项研究（209例患者）汇总了肿瘤坏死因子-α（TNF-α）; 8项研究（165例患者）汇总了白细胞介素-6（IL-6）。选择以下炎症标志物：CRP、TNF-α和IL-6。C反应蛋白：研究水平平均值范围为CPAP治疗前0.18 - 0.85 mg/dl，CPAP治疗后0.10 - 0.72 mg/dl。在研究水平上，平均差异范围为-0.05至0.50。合并平均差异为0.14 [95%置信区间0.08至0.20，p < 0.00001]。该终点存在异质性（df = 13，p < 0.00001，I2 = 95%）。肿瘤坏死因子-α：CPAP治疗前研究水平平均值范围为1.40 - 50.24 pg/ml，CPAP治疗后为1.80 - 28.63 pg/ml。研究水平的平均差异范围为-1.23至21.61。合并平均差异为1.14 [95%置信区间0.12 - 2.15，p = 0.03]。该终点存在异质性（df = 8，p < 0.00001，I2 = 89%）。白细胞介素-6：CPAP治疗前研究水平平均值范围为1.2 - 131.66 pg/ml，CPAP治疗后为0.45 - 66.04 pg/ml。在研究水平上，平均差异范围为-0.40至65.62。合并平均差异为1.01 [95%置信区间-0.00至2.03，p = 0.05]。该终点存在异质性（df = 7，p < 0.00001，I2 = 95%）。只有公布的数据。汇总的研究主要是小型、非随机试验。CPAP治疗睡眠呼吸暂停可改善炎症标志物水平
Obstructive sleep apnea (OSA) is associated with coronary artery disease (CAD). Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to CAD in patients with OSA. Treatment with continuous positive airway pressure (CPAP) has been shown to change levels of inflammatory markers. We analyzed data from published studies by a systematic meta-analysis. To asses if treatment for sleep apnea by CPAP will affect levels of inflammatory markers. PubMed, Embase and Cochrane library. Study eligibility criteria full text English studies of adult, human subjects, addressing values of at least one of the inflammatory markers before and after CPAP treatment. We used the definition of OSA as an apnea-hypopnea index (AHI) of ≥ 5/h, reported values in mean and standard deviation or median with range. Adult, human. CPAP treatment for OSA. A total of 3835 studies were reviewed for inclusion, while 23 studies pooled for analysis. A total of 14 studies with 771 patients were pooled for C-reactive protein (CRP); 9 studies with 209 patients were pooled for tumor necrosis factor-alpha (TNF-α); and 8 studies with 165 patients were pooled for interleukin-6 (IL-6). The following inflammatory markers were chosen: CRP, TNF-α, and IL-6. C-reactive protein: Study level means ranged from 0.18 to 0.85 mg/dl before CPAP treatment and 0.10 to 0.72 mg/dl after CPAP treatment. Mean differences, at a study level, ranged from −0.05 to 0.50. The pooled mean difference was 0.14 [95% confidence interval 0.08 to 0.20, p < 0.00001]. There was heterogeneity in this endpoint (df = 13, p < 0.00001, I2 = 95%). Tumor necrosis factor-α: Study level means ranged from 1.40 to 50.24 pg/ml before CPAP treatment and 1.80 to 28.63 pg/ml after CPAP treatment. Mean differences, at a study level, ranged from −1.23 to 21.61. The pooled mean difference was 1.14 [95% confidence interval 0.12 to 2.15, p = 0.03]. There was heterogeneity in this endpoint (df = 8, p < 0.00001, I2 = 89%). Interleukin-6: Study level means ranged from 1.2 to 131.66 pg/ml before CPAP treatment and 0.45 to 66.04 pg/ml after CPAP treatment. Mean differences, at a study level, ranged from −0.40 to 65.62. The pooled mean difference was 1.01 [95% confidence interval −0.00 to 2.03, p = 0.05]. There was heterogeneity in this endpoint (df = 7, p < 0.00001, I2 = 95%). Only published data. Studies pooled were mainly small, non-randomized trials. Sleep apnea treatment with CPAP improves levels of inflammatory markers.
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4
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Hozo SP;Djulbegovic B;Hozo I
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