Povitz Marcus, Bolo Carmelle E, Heitman Steven J, Tsai Willis H, Wang JianLi, James Matthew T
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Western University, London, Ontario, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
PLoS Med. 2014 Nov 25;11(11):e1001762. doi: 10.1371/journal.pmed.1001762. eCollection 2014 Nov.
Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality, and decreased quality of life. Treatment with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is effective for many symptoms of OSA. However, it remains controversial whether treatment with CPAP or MAD also improves depressive symptoms.
We performed a systematic review and meta-analysis of randomized controlled trials that examined the effect of CPAP or MADs on depressive symptoms in patients with OSA. We searched Medline, EMBASE, the Cochrane Central Registry of Controlled Trials, and PsycINFO from the inception of the databases until August 15, 2014, for relevant articles. In a random effects meta-analysis of 19 identified trials, CPAP treatment resulted in an improvement in depressive symptoms compared to control, but with significant heterogeneity between trials (Q statistic, p<0.001; I(2) = 71.3%, 95% CI: 54%, 82%). CPAP treatment resulted in significantly greater improvement in depressive symptoms in the two trials with a higher burden of depression at baseline (meta-regression, p<0.001). The pooled standardized mean difference (SMD) in depressive symptoms with CPAP treatment in these two trial populations with baseline depression was 2.004 (95% CI: 1.387, 2.621), compared to 0.197 (95% CI: 0.059, 0.334) for 15 trials of populations without depression at baseline. Pooled estimates of the treatment effect of CPAP were greater in parallel arm trials than in crossover trials (meta-regression, p = 0.076). Random effects meta-analysis of five trials of MADs showed a significant improvement in depressive symptoms with MADs versus controls: SMD = 0.214 (95% CI: 0.026, 0.401) without significant heterogeneity (I(2) = 0%, 95% CI: 0%, 79%). Studies were limited by the use of depressive symptom scales that have not been validated specifically in people with OSA.
CPAP and MADs may be useful components of treatment of depressive symptoms in individuals with OSA and depression. The efficacy of CPAP and MADs compared to standard therapies for depression is unknown. Please see later in the article for the Editors' Summary.
阻塞性睡眠呼吸暂停（OSA）与发病率和死亡率增加以及生活质量下降相关。持续气道正压通气（CPAP）或下颌前移装置（MADs）治疗对OSA的许多症状有效。然而，CPAP或MAD治疗是否也能改善抑郁症状仍存在争议。
我们对随机对照试验进行了系统评价和荟萃分析，这些试验研究了CPAP或MADs对OSA患者抑郁症状的影响。我们检索了Medline、EMBASE、Cochrane对照试验中央注册库和PsycINFO，从数据库建立至2014年8月15日，以查找相关文章。在对19项纳入试验的随机效应荟萃分析中，与对照组相比，CPAP治疗可改善抑郁症状，但试验间存在显著异质性（Q统计量，p<0.001；I² = 71.3%，95%CI：54%，82%）。在两项基线抑郁负担较高的试验中，CPAP治疗导致抑郁症状改善更为显著（meta回归，p<0.001）。在这两个有基线抑郁的试验人群中，CPAP治疗抑郁症状的合并标准化均数差（SMD）为2.004（95%CI：1.387，2.621），而在15项基线无抑郁人群的试验中为0.197（95%CI：0.059，0.334）。CPAP治疗效果的合并估计值在平行组试验中比在交叉试验中更大（meta回归，p = 0.076）。对五项MADs试验的随机效应荟萃分析显示，与对照组相比，MADs可显著改善抑郁症状：SMD = 0.214（95%CI：0.026，0.401），无显著异质性（I² = 0%，95%CI：0%，79%）。研究受到使用未在OSA患者中专门验证的抑郁症状量表的限制。
CPAP和MADs可能是治疗OSA合并抑郁患者抑郁症状的有用组成部分。与抑郁症标准疗法相比，CPAP和MADs的疗效尚不清楚。编辑总结请见本文后文。
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