心力衰竭患者睡眠呼吸障碍治疗方法的比较效果：一项全面的系统评价和网状Meta分析。
Comparative effectiveness of therapies for sleep-disordered breathing in heart failure patients: A comprehensive systematic review and network meta-analysis.
作者信息
Lin Yuhan, Chen Ying, Tu Wenqing, Mai Bifang, Guo Danying, Li Yuan, Chen Yongtong, Xie Shuanglun, Chen Yuyang
机构信息
Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China.
Department of Hematology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Shenzhen, 518000, China.
出版信息
Respir Med. 2025 Jan;236:107907. doi: 10.1016/j.rmed.2024.107907. Epub 2024 Dec 5.
BACKGROUND
The prevalence of sleep-disordered breathing (SDB) in patients with heart failure (HF) is a significant concern, leading to adverse outcomes. This network meta-analysis (NMA) is dedicated to evaluate the relative effectiveness of diverse therapeutic approaches for SDB treatments in the context of HF.
METHODS
An extensive search up to May 19, 2023, was implemented in PubMed, Cochrane, Embase, and Web of Science to identify randomized controlled trials (RCTs). These trials compared adaptive servo ventilation (ASV), automatic positive airway pressure (APAP), Bi-level positive pressure ventilation (Bi-level PPV), continuous positive airway pressure (CPAP), and oxygen therapy against placebo or standard treatment. Key outcomes included cardiac function indicators (left ventricular ejection fraction [LVEF], plasma B-type natriuretic peptide [BNP] levels), polysomnography data (apnea-hypopnea index [AHI], Mean and Minimum Oxygen Saturation), and patient-reported quality of life measures (Epworth sleepiness scale [ESS]). A random-effects Bayesian NMA was utilized to evaluate and compare the efficacy of these interventions.
RESULTS
The study revealed significant therapeutic effects of different interventions in sleep apnea patients. For patients with obstructive sleep apnea (OSA), CPAP demonstrated superior efficacy in enhancing average oxygen saturation (mean difference (MD) = 0.98; 95 % credible interval (CI) [0.07,2.09]), improving LVEF (MD = 5.66; 95 % CI [0.71, 10.08]), and reducing AHI (MD = -20.61; 95 % CI [-33.84, -9.9]). In the case of central sleep apnea (CSA), the therapeutic approaches showed varying degrees of effectiveness. CPAP proved most effective for enhancing average oxygen saturation(MD = 1.1; 95 % CI [0.26,1.98]). ASV was the most effective in lowering AHI (MD = -32.11; 95 % CI [-47.5, -17.16]), increasing lowest oxygen saturation (MD = 8.14; 95 % CI [1.72,14.92]), and enhancing LVEF (MD = 6.58; 95 % CI [0.06,12.49]).
CONCLUSION
No single SDB treatment uniformly benefits all clinical indicators in SDB and HF patients.
背景
心力衰竭（HF）患者中睡眠呼吸障碍（SDB）的患病率是一个重大问题，会导致不良后果。这项网络荟萃分析（NMA）致力于评估在HF背景下SDB治疗的不同治疗方法的相对有效性。
方法
截至2023年5月19日，在PubMed、Cochrane、Embase和Web of Science中进行了广泛检索，以识别随机对照试验（RCT）。这些试验比较了适应性伺服通气（ASV）、自动气道正压通气（APAP）、双水平正压通气（Bi-level PPV）、持续气道正压通气（CPAP）和氧疗与安慰剂或标准治疗。主要结局包括心功能指标（左心室射血分数[LVEF]、血浆B型利钠肽[BNP]水平）、多导睡眠图数据（呼吸暂停低通气指数[AHI]、平均和最低血氧饱和度）以及患者报告的生活质量测量指标（爱泼华嗜睡量表[ESS]）。采用随机效应贝叶斯NMA来评估和比较这些干预措施的疗效。
结果
该研究揭示了不同干预措施对睡眠呼吸暂停患者有显著治疗效果。对于阻塞性睡眠呼吸暂停（OSA）患者，CPAP在提高平均血氧饱和度（平均差（MD）=0.98；95%可信区间（CI）[0.07,2.09]）、改善LVEF（MD=5.66；95%CI[0.71,10.08]）和降低AHI（MD=-20.61；95%CI[-33.84,-9.9]）方面显示出卓越疗效。对于中枢性睡眠呼吸暂停（CSA），治疗方法显示出不同程度的有效性。CPAP被证明在提高平均血氧饱和度方面最有效（MD=1.1；95%CI[0.26,1.98]）。ASV在降低AHI（MD=-32.11；95%CI[-47.5,-17.16]）、提高最低血氧饱和度（MD=8.14；95%CI[1.72,14.92]）和改善LVEF（MD=6.58；95%CI[0.06,12.49]）方面最有效。
结论
没有单一的SDB治疗方法能使SDB和HF患者的所有临床指标都得到一致的改善。
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