Deng Bo, Lai Fei, Zhang Manman, Xiong Chenyili, Chen Feng, Zhang Heng, Ma Yuanyuan, Zhou Daiying
Department of Otolaryngology Head and Neck Surgery, Chengdu Longquanyi First People's Hospital, Chengdu, China.
Department of Orthopedics, Chengdu Longquanyi First People's Hospital, Chengdu, China.
Sleep Breath. 2023 Aug;27(4):1217-1226. doi: 10.1007/s11325-022-02721-z. Epub 2022 Oct 10.
The purpose of this study was to compare the effectiveness of nasal pillows with standard nasal masks in the treatment of patients with obstructive sleep apnea (OSA).
A digitalized search was carried out in four different databases including PubMed, Scopus, EMBASE, and CENTRAL using relevant keywords along with a manual search in relevant journals. All comparative studies comparing outcomes of using a nasal pillow with the use of standard nasal masks for continuous positive airway pressure (CPAP) treatment in patients with OSA were included. The qualitative analysis was carried out by tabulating the demographic data. The quantitative data were subjected to meta-analysis. The quality of comparative studies (both retrospective and prospective cohorts) was evaluated using New-castle Ottawa scale (NOS).
A total of 14 studies (eight prospective and six retrospective) were included in the review. Of them, five studies were randomized and were of cross-over study design. No significant differences were observed in achieved CPAP and residual apnea-hypopnea index (AHI) levels between the nasal pillow and nasal mask with SMD - 0.05 95% CI [- 0.18, 0.09], p = 0.50 and SMD - 0.13 95% CI [- 0.28, 0.03], p = 0.12, respectively. However, nasal pillow usage was associated with better CPAP adherence with a difference of only + 0.29 min/night as compared to a standard nasal mask, with SMD 0.29 95% CI [0.07, 0.50], p = 0.009.
Nasal pillow and standard nasal mask were equally effective in terms of residual AHI level and achieved similar therapeutic CPAP pressures. However, the difference in CPAP adherence between groups, though statistically significant, is of questionable clinical significance.
本研究旨在比较鼻枕与标准鼻罩在治疗阻塞性睡眠呼吸暂停（OSA）患者中的有效性。
使用相关关键词在包括PubMed、Scopus、EMBASE和CENTRAL在内的四个不同数据库中进行数字化检索，并在相关期刊中进行手动检索。纳入所有比较使用鼻枕与标准鼻罩进行持续气道正压通气（CPAP）治疗OSA患者结局的比较研究。通过将人口统计学数据制成表格进行定性分析。对定量数据进行荟萃分析。使用纽卡斯尔渥太华量表（NOS）评估比较研究（回顾性和前瞻性队列）的质量。
该综述共纳入14项研究（8项前瞻性研究和6项回顾性研究）。其中，5项研究为随机交叉研究设计。鼻枕与鼻罩之间在达到的CPAP和残余呼吸暂停低通气指数（AHI）水平上未观察到显著差异，标准化均数差（SMD）分别为 -0.05，95%可信区间[-0.18, 0.09]，p = 0.50和SMD -0.13，95%可信区间[-0.28, 0.03]，p = 0.12。然而，使用鼻枕与更好的CPAP依从性相关，与标准鼻罩相比，每晚仅相差 +0.29分钟，SMD为0.29，95%可信区间[0.07, 0.50]，p = 0.009。
在残余AHI水平方面，鼻枕和标准鼻罩同样有效，且达到了相似的治疗CPAP压力。然而，两组之间CPAP依从性的差异虽然具有统计学意义，但临床意义存疑。
