Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University, Atlanta, GA, USA.
Departmento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
Sleep Med. 2017 Feb;30:7-14. doi: 10.1016/j.sleep.2016.06.001. Epub 2016 Jun 28.
To synthesize evidence from available studies on the relative efficacies of continuous positive airway pressure (CPAP), mandibular advancement device (MAD), supervised aerobic exercise training, and dietary weight loss in patients with obstructive sleep apnea (OSA).
Network meta-analysis of 80 randomized controlled trials (RCTs) short-listed from PubMed, SCOPUS, Web of science, and Cochrane register (inception - September 8, 2015).
Individuals with OSA.
CPAP, MADs, exercise training, and dietary weight loss.
CPAP decreased apnea-hypopnea index (AHI) the most [by 25.27 events/hour (22.03-28.52)] followed by exercise training, MADs, and dietary weight loss. While the difference between exercise training and CPAP was non-significant [-8.04 (-17.00 to 0.92), a significant difference was found between CPAP and MADs on AHI and oxygen desaturation index (ODI) [-10.06 (-14.21 to -5.91) and -7.82 (-13.04 to -2.59), respectively]. Exercise training significantly improved Epworth sleepiness scores (ESS) [by 3.08 (0.68-5.48)], albeit with a non-significant difference compared to MADs and CPAP.
CPAP is the most efficacious in complete resolution of sleep apnea and in improving the indices of saturation during sleep. While MADs offer a reasonable alternative to CPAP, exercise training which significantly improved daytime sleepiness (ESS) could be used as adjunctive to the former two.
综合分析目前关于持续气道正压通气（CPAP）、下颌前伸装置（MAD）、监督性有氧运动训练和饮食减肥治疗阻塞性睡眠呼吸暂停（OSA）患者的相对疗效的研究证据。
从 PubMed、SCOPUS、Web of Science 和 Cochrane 登记处（从 2015 年 9 月 8 日开始）短名单中，对 80 项随机对照试验（RCT）进行网络荟萃分析。
OSA 患者。
CPAP、MAD、运动训练和饮食减肥。
CPAP 降低呼吸暂停低通气指数（AHI）最多[25.27 次/小时（22.03-28.52）]，其次是运动训练、MAD 和饮食减肥。虽然运动训练与 CPAP 之间的差异无统计学意义[-8.04（-17.00 至 0.92）]，但 CPAP 与 MAD 之间在 AHI 和氧减指数（ODI）上存在显著差异[-10.06（-14.21 至-5.91）和-7.82（-13.04 至-2.59）]。运动训练显著改善了嗜睡评分（ESS）[3.08（0.68-5.48）]，尽管与 MAD 和 CPAP 相比，差异无统计学意义。
CPAP 是最有效的治疗方法，可以完全消除睡眠呼吸暂停，并改善睡眠期间的饱和度指标。虽然 MAD 是 CPAP 的一种合理替代方法，但显著改善日间嗜睡（ESS）的运动训练可以作为前两者的辅助治疗。
