阻塞性睡眠呼吸暂停患者上下颌前徙术的种族差异：一项系统评价和荟萃分析。
Racial variations in maxillomandibular advancement for obstructive sleep apnea: a systematic review and meta-analysis.
作者信息
Nanu Douglas P, Diemer Tanner J, Nguyen Shaun A, Tremont Timothy, Meyer Ted A, Abdelwahab Mohamed
机构信息
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Elson S. Floyd College of Medicine at Washington State University, Spokane, WA, USA.
出版信息
Sleep Breath. 2024 Dec 9;29(1):55. doi: 10.1007/s11325-024-03211-0.
PURPOSE
We aimed to explore alterations in polysomnographic, cephalometric, and subjective outcomes amongst different ethnic/racial groups after MMA for OSA.
METHODS
A meta-analysis was performed according to PRISMA reporting guidelines. The COCHRANE Library, CINAHL, PubMed, and Scopus were searched from inception to August 8, 2023. Each measure was weighted according to the number of patients affected. Heterogeneity among studies was assessed using χ2 and I2 statistics with fixed effects (I < 50%) and random effects (I ≥ 50%).
RESULTS
Twenty studies with a total of 469 patients (n = 257 Caucasians, n = 204 Asians, n = 8 Latinos) with a mean patient age of 40.0 years (range: 18-67; 95% CI: 38.0, 42.1). The mean difference for Caucasians were AHI: -39.6 (95% CI: -55.0, -24.1; p <.001), LSAT: 7.5 (95% CI: 5.7, 9.3; p <.0001), and ESS: -4.5 (95% CI: -5.6, -3.4; p <.0001). The mean difference for Asians were AHI: -42.7 (95% CI -49.3, -36.0; p <.0001), LSAT: 13.8 (95% CI: 10.0, 17.4; p <.0001), and ESS: -6.7 (95% CI: -9.9, -3.5; p <.0001). The mean difference for Latinos were AHI: -21.2 (95 CI%: -37.7, -4.6; p =.01), and ESS: -2.0 (-7.9, 3.9; p =.50). Greater reduction of AHI was seen in Asians vs. Caucasians and Asians vs. Latinos. Lastly, the reduction of ESS was significantly better for Asians vs. Caucasians.
CONCLUSION
The study highlights significant variations in MMA outcomes among different ethnic/racial groups. Asians tend to have more severe OSA preoperatively and experience greater postoperative improvements in AHI, LSAT, and ESS compared to Caucasians.
目的
我们旨在探讨阻塞性睡眠呼吸暂停（OSA）患者接受下颌骨牵张成骨术（MMA）后，不同种族/民族群体在多导睡眠图、头影测量和主观结果方面的变化。
方法
根据PRISMA报告指南进行荟萃分析。检索了从数据库建立到2023年8月8日的Cochrane图书馆、CINAHL、PubMed和Scopus。每项指标根据受影响患者的数量进行加权。使用χ2和I2统计量评估研究间的异质性，采用固定效应模型（I<50%）和随机效应模型（I≥50%）。
结果
20项研究共纳入469例患者（n=257例白种人，n=204例亚洲人，n=8例拉丁裔），患者平均年龄为40.0岁（范围：18 - 67岁；95%置信区间：38.0, 42.1）。白种人的平均差异为：呼吸暂停低通气指数（AHI）：-39.6（95%置信区间：-55.0, -24.1；p<0.001），最低血氧饱和度（LSAT）：7.5（95%置信区间：5.7, 9.3；p<0.0001），以及 Epworth嗜睡量表（ESS）：-4.5（95%置信区间：-5.6, -3.4；p<0.0001）。亚洲人的平均差异为：AHI：-42.7（95%置信区间 -49.3, -36.0；p<0.0001），LSAT：13.8（95%置信区间：10.0, 17.4；p<0.0001），以及ESS：-6.7（95%置信区间：-9.9, -3.5；p<0.0001）。拉丁裔的平均差异为：AHI：-21.2（95%置信区间：-37.7, -4.6；p = 0.01），以及ESS：-2.0（-7.9, 3.9；p = 0.50）。与白种人和拉丁裔相比，亚洲人的AHI降低幅度更大。最后，与白种人相比，亚洲人ESS的降低情况明显更好。
结论
该研究突出了不同种族/民族群体在MMA治疗结果上的显著差异。与白种人相比，亚洲人术前往往患有更严重的OSA，术后在AHI、LSAT和ESS方面的改善更大。
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