药物治疗阻塞性睡眠呼吸暂停：系统评价和荟萃分析。
Pharmacological treatment for obstructive sleep apnea: A systematic review and meta-analysis.
机构信息
Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Clinical Analysis and Toxicology, Universidade Federal do Rio Grande do Norte, RN, Brazil.
出版信息
Clinics (Sao Paulo). 2024 Feb 10;79:100330. doi: 10.1016/j.clinsp.2024.100330. eCollection 2024.
OBJECTIVE
Summarize the evidence on drug therapies for obstructive sleep apnea.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Embase, Scopus, Web of Science, SciELO, LILACS, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched on February 17th, 2023. A search strategy retrieved randomized clinical trials comparing the Apnea-Hypopnea Index (AHI) in pharmacotherapies. Studies were selected and data was extracted by two authors independently. The risk of bias was assessed using the Cochrane Risk of Bias tool. RevMan 5.4. was used for data synthesis.
RESULTS
4930 articles were obtained, 68 met inclusion criteria, and 29 studies (involving 11 drugs) were combined in a meta-analysis. Atomoxetine plus oxybutynin vs placebo in AHI mean difference of -7.71 (-10.59, -4.83) [Fixed, 95 % CI, I2 = 50 %, overall effect: Z = 5.25, p < 0.001]. Donepezil vs placebo in AHI mean difference of -8.56 (-15.78, -1.33) [Fixed, 95 % CI, I2 = 21 %, overall effect: Z = 2.32, p = 0.02]. Sodium oxybate vs placebo in AHI mean difference of -5.50 (-9.28, -1.73) [Fixed, 95 % CI, I2 = 32 %, overall effect: Z = 2.86, p = 0.004]. Trazodone vs placebo in AHI mean difference of -12.75 (-21.30, -4.19) [Fixed, 95 % CI, I2 = 0 %, overall effect: Z = 2.92, p = 0.003].
CONCLUSION
The combination of noradrenergic and antimuscarinic drugs shows promising results. Identifying endotypes may be the key to future drug therapies for obstructive sleep apnea. Moreover, studies with longer follow-up assessing the safety and sustained effects of these treatments are needed.
PROSPERO REGISTRATION NUMBER
CRD42022362639.
目的
总结阻塞性睡眠呼吸暂停药物治疗的证据。
方法
遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。于 2023 年 2 月 17 日在 PubMed、Embase、Scopus、Web of Science、SciELO、LILACS、Scopus、Cochrane 对照试验中心注册库和 ClinicalTrials.gov 上进行检索。检索策略检索了比较药物治疗中睡眠呼吸暂停低通气指数（AHI）的随机临床试验。由两名作者独立选择研究和提取数据。使用 Cochrane 偏倚风险工具评估偏倚风险。使用 RevMan 5.4 进行数据综合。
结果
共获得 4930 篇文章，符合纳入标准的有 68 篇，29 项研究（涉及 11 种药物）进行了荟萃分析。托莫西汀联合奥昔布宁与安慰剂相比，AHI 平均差值为-7.71（-10.59，-4.83）[固定，95%置信区间，I2=50%，总体效应：Z=5.25，p<0.001]。多奈哌齐与安慰剂相比，AHI 平均差值为-8.56（-15.78，-1.33）[固定，95%置信区间，I2=21%，总体效应：Z=2.32，p=0.02]。右佐匹克隆与安慰剂相比，AHI 平均差值为-5.50（-9.28，-1.73）[固定，95%置信区间，I2=32%，总体效应：Z=2.86，p=0.004]。曲唑酮与安慰剂相比，AHI 平均差值为-12.75（-21.30，-4.19）[固定，95%置信区间，I2=0%，总体效应：Z=2.92，p=0.003]。
结论
去甲肾上腺素能和抗毒蕈碱药物联合使用显示出有前景的结果。确定表型可能是阻塞性睡眠呼吸暂停未来药物治疗的关键。此外，需要进行具有更长随访时间的研究，以评估这些治疗方法的安全性和持续效果。
PROSPERO 注册号：CRD42022362639。
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