呼吸训练对阻塞性睡眠呼吸暂停的影响：系统评价和荟萃分析。
Effects of respiratory training on obstructive sleep apnea: systematic review and meta-analysis.
机构信息
Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Street Sydnei Antonio Rangel Santos, 238 - Santo Inacio, Curitiba, PR, 82010-330, Brazil.
Postgraduate Program in Dentistry, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
出版信息
Sleep Breath. 2022 Dec;26(4):1527-1537. doi: 10.1007/s11325-021-02536-4. Epub 2021 Dec 1.
PURPOSE
This systematic review sought to answer the following focused question: "What are the effects of respiratory training devices on obstructive sleep apnea (OSA) outcomes in adults?" METHODS : The acronym "PICOS" was used to determine eligibility criteria, which consists of (P population) = adults with mild to moderate OSA, (I intervention) = spirometry devices or breathing exercises, (C comparison) = compared to no breathing exercises in adults (> 18 years) with mild to moderate OSA, (O outcomes) = improved sleep quality (sleep quality indexes) and improved apnea-hypopnea indexes (AHI), (S study types) = randomized, pseudo-randomized, and non-randomized clinical trials. The search was performed in the following databases: PubMed/Medline, LILACS, Scopus, Web of Science, Scopus, and Cochrane Library, in addition to gray literature through Google Scholar, Proquest, and Open Grey. The risk of bias was assessed using the Cochrane Collaboration tool. The certainty of the evidence was assessed using the GRADE tool. Meta-analyses of random effects were performed for the outcomes of interest.
RESULTS
A total of 1171 references were found. Applying the eligibility criteria, six studies were included in qualitative synthesis. Expiratory exercises showed a decrease in the apnea-hypopnea index (AHI) when compared to baseline (MD = - 8.4; 95% CI = - 12.4 to - 4.4; I = 19%). There was a decrease in values compared to baseline (MD = - 4.4; 95% CI = - 8.2 to - 0.6; I = 0%) for the Epworth Sleepiness Scale (ESS), when considering the inspiratory exercises. Both groups of breathing exercises showed a significant decrease in the mean index assessed by the Pittsburgh Sleep Quality Index (PSQI).
CONCLUSION
Results of this meta-analysis suggests that breathing exercises lead to a measurable improvement in AHI for patients with mild to moderate OSA, as well as an improvement in sleep quality and daytime sleepiness.
SYSTEMATIC REVIEW REGISTRATION
CRD42020148513 (PROSPERO).
目的
本系统评价旨在回答以下聚焦问题：“呼吸训练设备对成人阻塞性睡眠呼吸暂停（OSA）结局的影响是什么？”
方法
使用首字母缩略词“PICOS”来确定纳入标准，包括（P 人群）=患有轻度至中度 OSA 的成年人，（I 干预）=肺活量计设备或呼吸练习，（C 比较）=与不进行呼吸练习的成年人（> 18 岁）进行比较，患有轻度至中度 OSA，（O 结局）=改善睡眠质量（睡眠质量指数）和改善呼吸暂停低通气指数（AHI），（S 研究类型）=随机、伪随机和非随机临床试验。在以下数据库中进行了检索：PubMed/Medline、LILACS、Scopus、Web of Science、Scopus 和 Cochrane Library，此外还通过 Google Scholar、Proquest 和 Open Grey 检索了灰色文献。使用 Cochrane 协作工具评估偏倚风险。使用 GRADE 工具评估证据的确定性。对感兴趣的结局进行了随机效应荟萃分析。
结果
共发现 1171 篇参考文献。应用纳入标准，有 6 项研究纳入定性综合分析。与基线相比，呼气练习可降低呼吸暂停低通气指数（AHI）（MD = -8.4；95%CI = -12.4 至-4.4；I = 19%）。与基线相比，吸气练习时，Epworth 嗜睡量表（ESS）的值降低（MD = -4.4；95%CI = -8.2 至-0.6；I = 0%）。两组呼吸练习均显著降低匹兹堡睡眠质量指数（PSQI）评估的平均指数。
结论
这项荟萃分析的结果表明，呼吸练习可使轻度至中度 OSA 患者的 AHI 得到可衡量的改善，并改善睡眠质量和白天嗜睡。
系统评价注册
CRD42020148513（PROSPERO）。
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