Department of Otolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
JAMA Netw Open. 2024 Aug 1;7(8):e2427557. doi: 10.1001/jamanetworkopen.2024.27557.
Pregnancy may contribute to the development or exacerbation of obstructive sleep apnea (OSA) and increase the risk of gestational complications. Continuous positive airway pressure (CPAP) is the first-line and criterion standard treatment for OSA and is regarded as the most feasible choice during pregnancy. However, the association between CPAP therapy in pregnant women with OSA and reduced gestational complications remains inconclusive.
To investigate the association between CPAP therapy in pregnant women with OSA and the reduction of adverse hypertensive outcomes during gestation.
Keyword searches of PubMed, Embase, and the Cochrane Database of Systematic Reviews and Clinical Trials were conducted from inception to November 5, 2023.
Original studies reporting the treatment effect of CPAP use on lowering hypertension and preeclampsia risks in pregnant women with OSA were selected.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed in the reporting of reviews. Data were independently extracted by 2 authors. Random-effects model meta-analyses were performed and risk ratios (RRs) reported. Subgroup analysis, meta-regression based on age and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and publication bias assessment were also conducted.
The primary outcome was the RR of gestational hypertension and preeclampsia between pregnant women with OSA receiving CPAP treatment and those who did not receive CPAP treatment.
Six original studies in 809 participants (mean age, 31.4 years; mean BMI, 34.0) were identified and systematically reviewed for meta-analysis. The pooled results showed significant differences between the intervention (CPAP use) and the control (non-CPAP use) groups in reducing the risk of gestational hypertension (RR, 0.65; 95% CI, 0.47-0.89; P = .008) and preeclampsia (RR, 0.70; 95% CI, 0.50-0.98; P = .04). Meta-regression revealed that patients' age (coefficient, -0.0190; P = .83) and BMI (coefficient, -0.0042; P = .87) were not correlated with reduction of risk of hypertension and preeclampsia.
These findings suggest that implementing CPAP treatment in pregnant women with OSA may reduce the risk of gestational hypertension and preeclampsia.
妊娠可能导致阻塞性睡眠呼吸暂停（OSA）的发展或恶化，并增加妊娠并发症的风险。持续气道正压通气（CPAP）是 OSA 的一线和标准治疗方法，被认为是妊娠期间最可行的选择。然而，CPAP 治疗 OSA 孕妇与降低妊娠并发症之间的关联仍不确定。
研究 OSA 孕妇 CPAP 治疗与降低妊娠期间不良高血压结局的关系。
从研究开始到 2023 年 11 月 5 日，对 PubMed、Embase 和 Cochrane 系统评价和临床试验数据库进行了关键词搜索。
选择了报告 CPAP 使用对降低 OSA 孕妇高血压和子痫前期风险的治疗效果的原始研究。
综述报告遵循了系统评价和荟萃分析的首选报告项目（PRISMA）指南。两位作者独立提取数据。进行了随机效应模型荟萃分析，并报告了风险比（RR）。还进行了亚组分析、基于年龄和体重指数（BMI；体重以千克为单位除以身高以米为单位）的荟萃回归分析以及发表偏倚评估。
主要结果是 OSA 孕妇接受 CPAP 治疗和未接受 CPAP 治疗的孕妇发生妊娠期高血压和子痫前期的 RR。
确定了 6 项针对 809 名参与者（平均年龄 31.4 岁；平均 BMI 34.0）的原始研究进行荟萃分析。汇总结果显示，干预组（CPAP 使用）与对照组（非 CPAP 使用）在降低妊娠期高血压风险方面存在显著差异（RR，0.65；95%CI，0.47-0.89；P=0.008）和子痫前期（RR，0.70；95%CI，0.50-0.98；P=0.04）。荟萃回归显示，患者年龄（系数，-0.0190；P=0.83）和 BMI（系数，-0.0042；P=0.87）与降低高血压和子痫前期风险无关。
这些发现表明，在 OSA 孕妇中实施 CPAP 治疗可能会降低妊娠期高血压和子痫前期的风险。
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