Department of Otorhinolaryngology, University of Campinas, Campinas, Brazil.
Department of Human Development and Rehabilitation, University of Campinas, Campinas, Brazil.
Sleep Breath. 2024 Aug;28(4):1563-1574. doi: 10.1007/s11325-024-03034-z. Epub 2024 Apr 20.
Obstructive sleep apnea (OSA) is a chronic disease with a high populational prevalence that is characterized as airway closure during sleep. Treatment is multidisciplinary and varies according to each case. Continuous positive airway pressure (CPAP), oral appliances, and surgery are the primary therapeutic options. Non-invasive conservative treatments such as sleep hygiene, positional therapy, physical exercises, and weight loss aim to reduce the worsening of the disease while being complementary to the invasive primary treatment.
To analyze the impact of non-invasive conservative therapies on the clinical manifestations of OSA syndrome (OSA), compared with other interventions.
This was a systematic review with meta-analysis. The searches were performed without filters for the time period, type of publication, or language. Randomized clinical trials on subjects over 18 years of age diagnosed with untreated OSA were included. Responses to non-invasive conservative treatment were compared with responses to the primary intervention. Primary outcomes were assessed using the Epworth Sleepiness Scale and/or Functional Outcomes of Sleep Questionnaire (FOSQ).
A total of eight studies were included in the review. The heterogeneity of the effect was estimated at 89.77%. Six studies compared conservative treatment with CPAP, one with oral appliances, and one with oropharyngeal exercises. Using the Epworth Sleepiness Scale measurements, the standardized difference in the estimated means, based on the random-effects model, was 0.457 (95% CI (1.082 to 0.169)) and the mean result did not differ significantly from zero (z = 1.43; p = 0.153). The conservative therapies assessed in this study improved the subjective quality of sleep, although the post-treatment ESE scores did not show significant results. The reduction in AHI and better outcomes in the evaluated domains, as well as in cognition and mood, were superior in the groups that received CPAP and IOD.
The most commonly used treatments of choice for OSA are invasive, including the use of CPAP, oral appliances, and surgeries, being the most utilized options. This study demonstrated that non-invasive conservative treatments, such as sleep hygiene, yield results as effective as invasive treatments. Further studies are needed to confirm this result and to predict whether invasive treatment can be used as the primary treatment or only as a supplement.
阻塞性睡眠呼吸暂停（OSA）是一种具有高人群患病率的慢性疾病，其特征是睡眠期间气道关闭。治疗是多学科的，并且根据每个病例而有所不同。持续气道正压通气（CPAP）、口腔器具和手术是主要的治疗选择。非侵入性保守治疗，如睡眠卫生、体位治疗、体育锻炼和减肥，旨在减轻疾病的恶化，同时补充侵入性的主要治疗。
分析非侵入性保守治疗对 OSA 综合征（OSA）临床症状的影响，与其他干预措施相比。
这是一项系统评价和荟萃分析。未对时间范围、出版物类型或语言进行筛选。纳入了对未经治疗的 OSA 患者进行的年龄在 18 岁以上的随机临床试验。将对非侵入性保守治疗的反应与对主要干预措施的反应进行比较。主要结局是使用 Epworth 睡眠量表和/或睡眠功能问卷（FOSQ）评估。
共纳入 8 项研究。效应的异质性估计为 89.77%。六项研究将保守治疗与 CPAP 进行比较，一项与口腔器具进行比较，一项与口咽运动进行比较。使用基于随机效应模型的估计均值的标准化差异，Epworth 睡眠量表测量结果为 0.457（95%CI（1.082 至 0.169）），均值结果与零无显著差异（z=1.43；p=0.153）。这项研究评估的保守治疗改善了睡眠的主观质量，尽管治疗后的 ESE 评分没有显示出显著结果。接受 CPAP 和 IOD 的组中，AHI 降低和评估域的更好结果，以及认知和情绪方面，都更优。
OSA 最常用的治疗选择是侵入性的，包括使用 CPAP、口腔器具和手术，是最常用的选择。本研究表明，非侵入性保守治疗，如睡眠卫生，与侵入性治疗一样有效。需要进一步的研究来证实这一结果，并预测侵入性治疗是否可以作为主要治疗或仅作为补充。
