Department of Allergy, Immunology, and Respiratory Medicine, Alfred Hospital, 55 Commercial Rd, Melbourne 3004, Australia.
Sleep and Circadian Medicine Laboratory, Department of Physiology and School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Road, Notting Hill, VIC 3168, Australia.
Sleep Med Rev. 2017 Dec;36:107-115. doi: 10.1016/j.smrv.2016.11.004. Epub 2016 Nov 18.
This review aimed to determine the effectiveness of positional modification techniques in preventing supine sleep, sleep-disordered breathing and other clinically important outcomes in patients with supine obstructive sleep apnea (OSA). Randomized controlled trials comparing positional modification techniques with any other therapy or placebo were included. Electronic searches of databases including CENTRAL, MEDLINE, CINAHL, Embase, and Web of Science up to April 2016 were performed. Meta-analysis was undertaken where possible. This comprehensive meta-analysis found benefit for positional modification techniques in those with supine OSA in terms of reduction in apnea-hypopnea index (AHI) and time spent supine. Whilst positional modification techniques were effective in terms of a reduction in AHI, continuous positive airway pressure (CPAP) was more effective than these techniques. A reliable diagnosis of supine OSA should be considered, and further research is required on patient-centred outcomes including comfort, barriers to adherence, cost-analysis, and long term outcomes including the effect on cardiovascular disease, the metabolic syndrome, and insulin resistance.
本综述旨在确定体位改变技术在预防仰卧位睡眠、睡眠呼吸障碍紊乱和其他仰卧位阻塞性睡眠呼吸暂停（OSA）患者临床重要结局方面的有效性。纳入了比较体位改变技术与任何其他治疗或安慰剂的随机对照试验。对包括 CENTRAL、MEDLINE、CINAHL、Embase 和 Web of Science 在内的数据库进行了截至 2016 年 4 月的电子检索。在可能的情况下进行了荟萃分析。这项全面的荟萃分析发现，对于仰卧位 OSA 患者，体位改变技术在减少呼吸暂停低通气指数（AHI）和仰卧时间方面具有益处。尽管体位改变技术在降低 AHI 方面有效，但持续气道正压通气（CPAP）比这些技术更有效。应该可靠地诊断出仰卧位 OSA，并需要进一步研究以患者为中心的结局，包括舒适度、依从性障碍、成本分析以及长期结局，包括对心血管疾病、代谢综合征和胰岛素抵抗的影响。
