Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile.
Faculty of Medicine, University of Concepcion, Concepcion, Chile.
Sleep Med Rev. 2021 Dec;60:101543. doi: 10.1016/j.smrv.2021.101543. Epub 2021 Aug 31.
Continuous positive airway pressure (CPAP) is the preferred therapy in patients with obstructive sleep apnea (OSA). However, data suggests treatment adherence is low. In recent years, telemedicine-based intervention (TM) has been evaluated to increase adherence. In this systematic review and meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy of TM on CPAP adherence in patients with OSA. Two independent reviewers explored five databases; the risk of bias (RoB) was evaluated using the Cochrane tool. Outcomes were defined as the mean difference (MD) in CPAP use per night and the proportion of patients with increased CPAP adherence of ≥4 h/night. The meta-analysis was conducted following the DerSimonian-Laird method, and the certainty of the evidence was rated according to GRADE. We included 16 RCTs including 3039 participants. The RoB was low in 12/16 studies. TM was associated with an increase in CPAP adherence of 29.2 min/night, I =75% (p < 0.01), and CPAP adherence ≧4 h/night, RR: 1.09 (1.02-1.17), I =22%. Subgroup analyses reported better results between three and 6 months, in the sleepy subgroup. Finally, based on the results obtained in this systematic review, there is favorable evidence regarding the treatment with TM in patients with OSA using CPAP. REVIEW REGISTRATION NUMBER: CRD42020165367.
持续气道正压通气（CPAP）是阻塞性睡眠呼吸暂停（OSA）患者的首选治疗方法。然而，数据表明治疗依从性较低。近年来，基于远程医疗的干预（TM）已被评估用于提高依从性。在这项对随机对照试验（RCT）的系统评价和荟萃分析中，我们评估了 TM 对 OSA 患者 CPAP 依从性的疗效。两名独立评审员探索了五个数据库；使用 Cochrane 工具评估偏倚风险（RoB）。结果定义为每晚 CPAP 使用的平均差异（MD）和 CPAP 依从性增加≥4 小时/晚的患者比例。荟萃分析采用 DerSimonian-Laird 方法进行，证据确定性根据 GRADE 进行评级。我们纳入了 16 项 RCT，包括 3039 名参与者。12/16 项研究的 RoB 较低。TM 与 CPAP 依从性增加 29.2 分钟/晚相关，I²=75%（p<0.01），CPAP 依从性≥4 小时/晚，RR：1.09（1.02-1.17），I²=22%。亚组分析报告称，在嗜睡亚组中，3 至 6 个月之间的结果更好。最后，根据本系统评价的结果，TM 治疗 OSA 患者使用 CPAP 的治疗具有有利证据。审查登记号：CRD42020165367。
