Department of Internal Medicine, Tainan Sin Lau Hospital, Tainan, Taiwan.
Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan.
J Sleep Res. 2022 Dec;31(6):e13686. doi: 10.1111/jsr.13686. Epub 2022 Jul 12.
Until now, no study has directly network meta-analysed the impact of nasal masks, nasal pillows and oronasal masks on continuous positive airway pressure therapy in patients with obstructive sleep apnea. This study aimed to meta-analyse the impact of three kinds of nasal interfaces with both network meta-analysis and pairwise comparison. PubMed, EMBASE, CENTRAL and ClinicalTrials.gov were systematically searched from inception to December 2020 for studies that compared the three types of nasal interfaces for treating obstructive sleep apnea with continuous positive airway pressure. The outcomes were residual apnea-hypopnea index, continuous positive airway pressure, and nightly average usage. The network meta-analysis was conducted using multivariate random-effects in a frequentist framework where three interfaces were ranked with the surface under the cumulative ranking probabilities. The pairwise comparison was conducted using random-effects meta-analysis. Twenty-nine articles comprising 6378 participants were included. The pairwise comparison showed both nasal masks and nasal pillows were associated with lower residual apnea-hypopnea index, lower continuous positive airway pressure, and higher continuous positive airway pressure adherence compared with oronasal masks. The surface under the cumulative ranking confirmed that nasal masks were associated with the lowest residual apnea-hypopnea index and highest adherence, while pillows were associated with the lowest continuous positive airway pressure. The meta-regression identified that lower pretreatment apnea-hypopnea index and continuous positive airway pressure determined during continuous positive airway pressure titration (versus determined during continuous positive airway pressure therapy) was associated with lower continuous positive airway pressure with nasal masks and nasal pillows. In conclusion, compared with oronasal masks, nasal masks and nasal pillows are better interfaces, especially in patients with lower pretreatment apnea-hypopnea index and those with the therapeutic pressure determined during continuous positive airway pressure titration.
到目前为止，还没有研究直接对鼻塞、鼻枕和口鼻面罩在阻塞性睡眠呼吸暂停患者持续气道正压治疗中的影响进行网络荟萃分析。本研究旨在通过网络荟萃分析和两两比较来荟萃分析这三种鼻接口的影响。从开始到 2020 年 12 月，系统地检索了 PubMed、EMBASE、CENTRAL 和 ClinicalTrials.gov，以寻找比较三种类型的鼻塞接口治疗阻塞性睡眠呼吸暂停与持续气道正压的研究。结果是残留呼吸暂停低通气指数、持续气道正压和夜间平均使用。网络荟萃分析采用多元随机效应在频繁主义框架中进行，其中三种接口用累积排序概率曲线下面积进行排序。两两比较采用随机效应荟萃分析。纳入了 29 篇文章，共 6378 名参与者。两两比较显示，与口鼻面罩相比，鼻塞和鼻枕均与较低的残留呼吸暂停低通气指数、较低的持续气道正压和较高的持续气道正压依从性相关。累积排序曲线下面积证实鼻塞与最低残留呼吸暂停低通气指数和最高依从性相关，而枕头与最低持续气道正压相关。元回归确定，较低的治疗前呼吸暂停低通气指数和持续气道正压在持续气道正压滴定期间（而非在持续气道正压治疗期间）确定与鼻塞和鼻枕的较低持续气道正压相关。总之，与口鼻面罩相比，鼻塞和鼻枕是更好的接口，尤其是在治疗前呼吸暂停低通气指数较低的患者和在持续气道正压滴定期间确定治疗压力的患者中。
