Liu Pan, Kong Weiguo, Fang Caijing, Zhu Kangxu, Dai Xiaohua, Meng Xiangming
Department of Emergency or ICU, Anhui Provincial Hospital of Integrated Traditional and Western Medicine, Hefei, China.
Graduate School of Anhui University of Traditional Chinese Medicine, Hefei, China.
Front Neurol. 2022 Oct 25;13:1037926. doi: 10.3389/fneur.2022.1037926. eCollection 2022.
To evaluate the efficacy and adverse effects of hypoglossal nerve stimulation in adolescents with down syndrome and obstructive sleep apnea.
A systematic search was conducted using PubMed, Web of Science, Embase, and Scopus databases. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search strategy used a combination of Medical Subject Headings and free words with "OR" and "AND." Articles were screened to extract data reporting apnea-hypopnea index, quality of life, voltage, follow-up duration, and complications. All included participants were adolescents with down syndrome and obstructive sleep apnea.
A total of 92 articles were identified, of which 9 articles met the inclusion criteria. A total of 106 patients were included. All the studies showed that patients receiving hypoglossal nerve stimulation experienced a significant decrease in apnea-hypopnea index (at least 50%). The pooled AHI was significantly lower in patients following treatment (mean AHI reduction 17.43 events/h, 95% confidence interval 13.98-20.88 events/h, < 0.001) after 2 case reports were excluded. The pooled OSA-18 were significantly decreased in 88 patients after treatment (mean OSA-18 reduction 1.67, 95% confidence interval 1.27-2.08, < 0.001) after excluding 5 studies. Four investigations examined the necessity to optimize stimulation voltage for arousal during treatment. The most common complication was pain or discomfort in the tongue or mouth. Most studies had relatively short patient follow-up periods, with the most extended follow-up being 44-58 months.
Hypoglossal nerve stimulation significantly reduces apnea-hypopnea index and improves the quality of life; and thus, could be a potential alternative therapy for obstructive sleep apnea in adolescents with down syndrome. The adolescent's age, potential complications, adverse events, long-term efficacy, and comfort, needs to be considered while performing hypoglossal nerve stimulation.
评估舌下神经刺激对唐氏综合征合并阻塞性睡眠呼吸暂停青少年的疗效及不良反应。
使用PubMed、Web of Science、Embase和Scopus数据库进行系统检索。该系统评价遵循系统评价和Meta分析的首选报告项目指南。综合检索策略采用医学主题词和自由词相结合的方式，用“OR”和“AND”连接。对文章进行筛选以提取报告呼吸暂停低通气指数、生活质量、电压、随访时间和并发症的数据。所有纳入的参与者均为唐氏综合征合并阻塞性睡眠呼吸暂停的青少年。
共识别出92篇文章，其中9篇符合纳入标准。共纳入106例患者。所有研究均表明，接受舌下神经刺激的患者呼吸暂停低通气指数显著降低（至少降低50%）。排除2例病例报告后，治疗后患者的合并呼吸暂停低通气指数显著降低（平均呼吸暂停低通气指数降低17.43次/小时，95%置信区间13.98 - 20.88次/小时，P < 0.001）。排除5项研究后，88例患者治疗后的合并阻塞性睡眠呼吸暂停生活质量量表（OSA-18）显著降低（平均OSA-18降低1.67，95%置信区间1.27 - 2.08，P < 0.001）。四项研究探讨了治疗期间优化刺激电压以唤醒的必要性。最常见的并发症是舌部或口腔疼痛或不适。大多数研究的患者随访期相对较短，最长随访时间为44 - 58个月。
舌下神经刺激可显著降低呼吸暂停低通气指数并改善生活质量；因此，可能是唐氏综合征青少年阻塞性睡眠呼吸暂停的一种潜在替代治疗方法。在进行舌下神经刺激时，需要考虑青少年的年龄、潜在并发症、不良事件、长期疗效和舒适度。
