持续正压通气与口腔矫正器治疗阻塞性睡眠呼吸暂停低通气综合征疗效的Meta分析  

Continuous positive airway pressure and oral appliances on treatment of obstructive sleep apnea hypopnea syndrome: A Meta-analysis

作　　者：张婷[1] 江灿[1] 黄庆玲[1] 雷莉[1] 毛丹丹[1] 王彦婷[1] 乐发国[1] ZHANG Ting;JIANG Can;HUANG Qing-ling;LEI Li;MAO Dan-dan;WANG Yan-ting;YUE Fa-guo(Department of Sleep and Psychology,Daping Hospital,Research Institute of Surgery,Army Medical University of Chinese PLA,Chongqing 40001 O,China)

机构地区：[1]陆军军医大学大坪医院野战外科研究所,重庆400010

出　　处：《解放军医学杂志》2018年第7期621-627,共7页Medical Journal of Chinese People's Liberation Army

摘　　要：目的系统评价持续正压通气(CPAP)与口腔矫正器(OA)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法计算机检索Pub Med、EMbase、Cochrane Library、CNKI、VIP和Wanfang Data数据库,搜集持续正压通气与口腔矫正器治疗OSAHS相关的随机对照试验(RCT)和随机交叉试验,检索时限均为从建库至2017年9月。由两位评价者按照纳入与排除标准独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入13个研究,1141例OSAHS患者。Meta分析结果显示:与OA组比较,CPAP组能有效降低OSAHS患者的呼吸暂停低通气指数(MD=–9.79,95%CI–11.88~–7.69,P<0.00001)、Epworth嗜睡量表(MD=–0.82,95%CI–1.36~–0.29,P=0.003)及微觉醒指数(MD=–5.65,95%CI–8.74~–2.55,P=0.0004);提高夜间最低血氧饱和度(MD=4.42,95%CI 3.14~5.70,P<0.00001);在快眼动睡眠(MD=0.99,95%CI–1.37~3.35,P=0.41)及睡眠效率(MD=–0.48,95%CI–1.04~–0.07,P=0.09)方面,两组无明显差异;但CPAP组在体重指数(MD=0.29,95%CI 0.01~0.57,P=0.04)方面的效果比OA组差。结论持续正压通气治疗可降低OSAHS患者呼吸暂停低通气指数、Epworth嗜睡量表及微觉醒指数,并提高夜间最低血氧饱和度。Objective To systematically evaluate the curative effect of continuous positive airway pressure（CPAP） and oral appliances（OA） for obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods Data were electronically searched from the databases including Pub Med, EMbase, Cochrane Library, CNKI, VIP and Wanfang to collect the randomized controlled trials（RCTs） and randomized crossover study of CPAP and OA for OSAHS patients from the inception of databases mentioned above to September 2017. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by Rev Man 5.3 software. Results A total of 13 studies involving 1141 OSAHS patients were included. Compared with the OA group, the CPAP group could significantly reduce the apnea hypopnea index [AHI, MD=–9.79, 95%CI（–11.88, –7.69）, P0.00001], Epworth somnolescent starts scale [ESS, MD=–0.82, 95%CI（–1.36, –0.29）, P=0.003] and Arousal index [MD=–5.65, 95%CI（–8.74, –2.55）, P=0.0004]; and improve the minimum night blood oxygen saturation [Sa O2 min, MD=4.42, 95%CI（3.14, 5.70）, P0.00001]. W hile there were no significant difference in rapid eyes movement sleep [REM, MD=0.99, 95%CI（–1.37, 3.35）, P=0.41] and sleep efficiency [MD=–0.48, 95%CI（–1.04, –0.07）, P=0.09] between the two groups. But the CPAP group could not reduce the body mass index [BMI, MD=0.29, 95%CI（0.01, 0.57）, P=0.04]. Conclusion CPAP can reduce the AHI, ESS and arousal index and improve the Sa O2 min in OSAHS patients.

关 键 词：持续正压通气 口腔矫正器 阻塞性睡眠呼吸暂停低通气综合征 系统评价 META分析 

分 类 号：R767[医药卫生—耳鼻咽喉科]