The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China.
Department of Respiratory and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
Sleep Breath. 2023 Dec;27(6):2123-2137. doi: 10.1007/s11325-023-02829-w. Epub 2023 Apr 29.
Studies show that patients with obstructive sleep apnea (OSA) are more likely than the general population to have psychological disorders such as depression. However, it is less clear how OSA treatment affects this association. This meta-analysis aimed to assess whether or not continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) reduce depression symptoms in patients with OSA.
We searched Pubmed, Embase, Web of Science, and Cochrane Library from creating the databases until November 2022. Our analysis included RCTs that examined CPAP and MAD treatment effectiveness for depression in patients with OSA.
We identified 17 CPAP studies comprising 1,931 patients for inclusion in the meta-analysis. The results of the meta-analysis using a fixed effects model found that CPAP improved depressed mood in patients with OSA relative to controls (SMD = 0.27;95% CI:0.18,0.36), with small heterogeneity among trials (I = 8.1% < 50%, P = 0.359). We performed subgroup analyses on three factors: the length of trial follow-up, patient adherence data, and depression assessment scales. The meta-analysis also identified six MAD studies involving 315 patients. According to this analysis, there was no heterogeneity between studies (I = 0%, P = 0.748). MADs did not significantly improve depression symptoms compared to controls, indicating a combined effect of SMD = 0.07 (95% CI: - 0.15,0.29), P > 0.05.
The present findings confirm that CPAP may improve depressive symptoms in patients with OSA. However, the review results suggest that MADs have no significant effect on depressive symptoms in patients with OSA, a finding that is different from the results of previous meta-analyses.
研究表明，阻塞性睡眠呼吸暂停（OSA）患者比一般人群更容易出现心理障碍，如抑郁症。然而，OSA 治疗如何影响这种关联尚不清楚。本荟萃分析旨在评估持续气道正压通气（CPAP）和下颌前伸装置（MADs）是否能降低 OSA 患者的抑郁症状。
我们检索了 Pubmed、Embase、Web of Science 和 Cochrane Library，从创建数据库到 2022 年 11 月。我们的分析包括 RCTs，这些 RCT 研究了 CPAP 和 MAD 治疗 OSA 患者抑郁的效果。
我们确定了 17 项 CPAP 研究，其中包括 1931 名患者纳入荟萃分析。使用固定效应模型的荟萃分析结果发现，CPAP 治疗可改善 OSA 患者的抑郁情绪，与对照组相比（SMD=0.27；95%CI：0.18，0.36），试验之间的异质性较小（I=8.1%<50%，P=0.359）。我们对三个因素进行了亚组分析：试验随访时间、患者依从性数据和抑郁评估量表。荟萃分析还确定了六项 MAD 研究，涉及 315 名患者。根据这项分析，研究之间没有异质性（I=0%，P=0.748）。与对照组相比，MADs 并未显著改善抑郁症状，表明 SMD=0.07（95%CI：-0.15，0.29），P>0.05，合并效应。
本研究结果证实 CPAP 可能改善 OSA 患者的抑郁症状。然而，综述结果表明，MADs 对 OSA 患者的抑郁症状没有显著影响，这与之前的荟萃分析结果不同。
