White J, Cates C, Wright J
Respiratory Medicne, York District Hospital, Wigginton Rd, York, North Yorks, UK, YO31 8HE.
Cochrane Database Syst Rev. 2002(2):CD001106. doi: 10.1002/14651858.CD001106.
Obstructive sleep apnoea is the periodic reduction (hypopnoea) or cessation (apnoea) of breathing due to narrowing or occlusion of the upper airway during sleep. The main symptom is daytime sleepiness although there it has been linked to premature death, hypertension, ischaemic heart disease, stroke and road traffic accidents.
The main treatment for sleep apnoea is with continuous positive airways pressure (CPAP) treatment, which consists of a flow generator and mask. These are used at night to prevent apnoea, hypoxia and sleep disturbance. The objective was to assess the effects of CPAP in the treatment of obstructive sleep apnoea in adults.
We searched the Cochrane Airways Group RCT register (MEDLINE 1966 to 2000, Embase 1974 to 2000, Cinahl 1982 to 2000) and the reference lists of articles. We consulted experts in the field.
Randomised trials comparing nocturnal CPAP with placebo or other treatments in adults with obstructive sleep apnoea and an apnoea/hypopnoea index greater than five per hour.
Trial quality was assessed and two reviewers extracted data independently. Study authors were contacted for missing information.
Twelve trials involving 475 people were included. Most studies had methodological shortcomings. Most trials were of crossover design. Compared with placebo, CPAP showed significant improvements in objective and subjective sleepiness and several quality of life and depression measures. Patients preferred CPAP to placebo (odds ratio 0.4, 95% confidence interval 0.2 to 0.8). There was no significant effect on daytime blood pressure. Compared with oral appliances, CPAP significantly improved the apnoea/hypopnoea index (weighted mean difference -7.3, 95% confidence interval -10.0 to -4.7) and minimum oxygen saturation during sleep. Patients strongly preferred the oral appliance to CPAP (odds ratio 9.5, 95% confidence interval 4.3 to 21.1).
REVIEWER'S CONCLUSIONS: CPAP is more effective than placebo in improving sleepiness and quality of life measures for people with obstructive sleep apnoea. It is more effective than oral appliances in improving respiratory disturbances. Although patients prefer CPAP to placebo, they preference oral appliances to CPAP.
阻塞性睡眠呼吸暂停是指睡眠期间由于上呼吸道狭窄或阻塞导致的呼吸周期性减少（呼吸浅慢）或停止（呼吸暂停）。主要症状是日间嗜睡，尽管它还与过早死亡、高血压、缺血性心脏病、中风和道路交通事故有关。
睡眠呼吸暂停的主要治疗方法是持续气道正压通气（CPAP）治疗，它由一个气流发生器和面罩组成。这些在夜间使用以预防呼吸暂停、缺氧和睡眠障碍。目的是评估CPAP治疗成人阻塞性睡眠呼吸暂停的效果。
我们检索了Cochrane气道组随机对照试验注册库（MEDLINE 1966年至2000年、Embase 1974年至2000年、Cinahl 1982年至2000年）以及文章的参考文献列表。我们咨询了该领域的专家。
比较夜间CPAP与安慰剂或其他治疗方法治疗阻塞性睡眠呼吸暂停且呼吸暂停/呼吸浅慢指数每小时大于5次的成人的随机试验。
评估试验质量，两名评价员独立提取数据。联系研究作者获取缺失信息。
纳入了12项涉及475人的试验。大多数研究存在方法学缺陷。大多数试验为交叉设计。与安慰剂相比，CPAP在客观和主观嗜睡以及多项生活质量和抑郁指标方面有显著改善。患者更喜欢CPAP而非安慰剂（比值比0.4，95%置信区间0.2至0.8）。对日间血压无显著影响。与口腔矫治器相比，CPAP显著改善了呼吸暂停/呼吸浅慢指数（加权均数差-7.3，95%置信区间-10.0至-4.7）以及睡眠期间的最低血氧饱和度。患者强烈更喜欢口腔矫治器而非CPAP（比值比9.5，95%置信区间4.3至21.1）。
对于阻塞性睡眠呼吸暂停患者，CPAP在改善嗜睡和生活质量指标方面比安慰剂更有效。在改善呼吸紊乱方面，它比口腔矫治器更有效。尽管患者更喜欢CPAP而非安慰剂，但他们更喜欢口腔矫治器而非CPAP。
