远程医疗干预对提高阻塞性睡眠呼吸暂停患者持续气道正压通气依从性的效果：随机对照试验的荟萃分析。
Effects of telemedicine interventions in improving continuous positive airway pressure adherence in patients with obstructive sleep apnoea: a meta-analysis of randomised controlled trials.
机构信息
Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Otolaryngology Head and Neck Surgery & Center of Sle-ep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.
出版信息
Sleep Breath. 2021 Dec;25(4):1761-1771. doi: 10.1007/s11325-021-02292-5. Epub 2021 Mar 10.
PURPOSE
This meta-analysis was conducted to assess the effects of telemedicine interventions on continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnoea (OSA).
METHODS
The PubMed, Cochrane Library, OVID, Web of Science and EBSCO host databases were searched from January 2004 to February 2020 for randomised controlled trials (RCTs) that assessed the effects of telemedicine interventions on CPAP adherence in patients with OSA. The study inclusion criteria were RCTs that compared patients who received telemedicine interventions with a control group and reported a change in CPAP adherence. The primary outcome was the improvement in CPAP adherence.
RESULTS
In total, there were 11 RCTs (n = 1358) with quantitative analyses. Intervention times ranged from 1 to 6 months. Compared to controls, the telemedicine group exhibited better adherence to CPAP therapy (pooled mean difference (MD) = 0.57, 95% CI = 0.33 to 0.80, I = 7%, p < 0.00001). We performed sensitivity analyses by the type of telemedicine intervention, comorbidity burden, and OSA severity to explore whether or not their effect sizes may have affected the time of CPAP application. We performed subgroup analyses by follow-up duration, age, and OSA Epworth sleepiness scale (ESS) symptoms to determine if their effect sizes may have affected the time of CPAP application. However, these analyses did not change the statistical significance of the pooled estimate.
CONCLUSIONS
The use of telemedicine for up to 6 months may enhance CPAP adherence in patients with OSA, when compared to no intervention. Our study was searched from January 2004 to February 2020 for randomised controlled trials (RCTs) that assessed the effects of telemedicine interventions on CPAP adherence in patients with OSA. Future studies can continue to search for articles after February 2020.
目的
本荟萃分析旨在评估远程医疗干预对阻塞性睡眠呼吸暂停（OSA）患者持续气道正压通气（CPAP）依从性的影响。
方法
检索 2004 年 1 月至 2020 年 2 月期间的 PubMed、Cochrane 图书馆、OVID、Web of Science 和 EBSCOhost 数据库，以评估远程医疗干预对 OSA 患者 CPAP 依从性的影响的随机对照试验（RCT）。研究纳入标准为比较接受远程医疗干预的患者和对照组并报告 CPAP 依从性变化的 RCT。主要结局为 CPAP 依从性的改善。
结果
共有 11 项 RCT（n = 1358）进行了定量分析。干预时间从 1 到 6 个月不等。与对照组相比，远程医疗组的 CPAP 治疗依从性更好（汇总平均差异（MD）= 0.57，95%置信区间（CI）= 0.33 至 0.80，I = 7%，p < 0.00001）。我们通过远程医疗干预类型、合并症负担和 OSA 严重程度进行敏感性分析，以探讨其效应大小是否可能影响 CPAP 应用时间。我们通过随访时间、年龄和 OSA 嗜睡量表（ESS）症状进行亚组分析，以确定其效应大小是否可能影响 CPAP 应用时间。然而，这些分析并没有改变汇总估计的统计学意义。
结论
与无干预相比，使用远程医疗干预最多 6 个月可能会提高 OSA 患者的 CPAP 依从性。我们的研究从 2004 年 1 月至 2020 年 2 月期间检索了评估远程医疗干预对 OSA 患者 CPAP 依从性影响的随机对照试验（RCT）。未来的研究可以继续在 2020 年 2 月之后搜索文章。
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