Kuhn Eric, Schwarz Esther I, Bratton Daniel J, Rossi Valentina A, Kohler Malcolm
Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.
Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland.
Chest. 2017 Apr;151(4):786-794. doi: 10.1016/j.chest.2017.01.020. Epub 2017 Jan 24.
Untreated OSA is associated with impaired health-related quality of life (QoL) and excessive daytime sleepiness, which have been shown to improve with treatment. The aim was to compare the effects of CPAP and a mandibular advancement device (MAD) on health-related QoL in OSA.
MEDLINE and the Cochrane Library were searched up to November 2015 for randomized controlled trials (RCTs) comparing the effect of CPAP, MADs, or an inactive control treatment on health-related QoL assessed by the 36-Item Short Form Health Survey (SF-36) in OSA. Extraction of study characteristics, quality, and bias assessment were independently performed by three authors. A network meta-analysis using multivariate random-effects meta-regression was performed to assess treatment effects on the mental component score (MCS) and the physical component score (PCS) of the SF-36.
Of 1,491 identified studies, 23 RCTs were included in the meta-analysis (2,342 patients). Compared with an inactive control, CPAP was associated with a 1.7 point (95% CI, 0.1-3.2; P = .036) improvement in the MCS and a 1.7 point (95% CI, 0.5-2.9; P = .005) improvement in the PCS. MADs were associated with a 2.4 point (95% CI, 0.0-4.9; P = .053) and a 1.5 point (95% CI, -0.2 to 3.2; P = .076) improvement in the MCS and PCS, respectively, compared with inactive control treatments. There were no statistically significant differences between treatment effects of CPAP and MAD on the SF-36 scores.
CPAP is effective in improving health-related QoL in OSA, and MADs may be just as effective, but further RCTs comparing the two treatments are required.
未经治疗的阻塞性睡眠呼吸暂停（OSA）与健康相关生活质量（QoL）受损及日间过度嗜睡有关，而治疗已显示可改善这些情况。目的是比较持续气道正压通气（CPAP）和下颌前移装置（MAD）对OSA患者健康相关生活质量的影响。
检索MEDLINE和Cochrane图书馆截至2015年11月的随机对照试验（RCT），这些试验比较了CPAP、MAD或无活性对照治疗对通过OSA患者的36项简短健康调查（SF-36）评估的健康相关生活质量的影响。三位作者独立进行研究特征提取、质量评估和偏倚评估。使用多变量随机效应荟萃回归进行网络荟萃分析，以评估对SF-36的心理成分评分（MCS）和身体成分评分（PCS）的治疗效果。
在1491项已识别的研究中，23项RCT被纳入荟萃分析（2342例患者）。与无活性对照相比，CPAP使MCS提高1.7分（95%CI，0.1 - 3.2；P = 0.036），使PCS提高1.7分（95%CI，0.5 - 2.9；P = 0.005）。与无活性对照治疗相比，MAD分别使MCS提高2.4分（95%CI，0.0 - 4.9；P = 0.053），使PCS提高1.5分（95%CI， - 0.2至3.2；P = 0.076）。CPAP和MAD对SF-36评分的治疗效果之间无统计学显著差异。
CPAP可有效改善OSA患者的健康相关生活质量，MAD可能同样有效，但需要进一步的RCT来比较这两种治疗方法。
