持續氣道正壓通氣治療對阻塞性睡眠呼吸暫停低通氣綜合征患者療效的系統評價_《中國循證醫學雜志》

作者：

葉紅 ,  李濤平 , 馮媛 , 申海燕 , 劉愛華

南方醫科大學南方醫院呼吸睡眠中心（廣州 510515）;

關鍵詞：

持續氣道正壓通氣阻塞性睡眠呼吸暫停生活質量系統評價

DOI：

10.7507/1672-2531.20090189

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目的　系統評價持續氣道正壓通氣治療（CPAP）對不同程度的阻塞性睡眠呼吸暫停低通氣綜合征（obstructive sleep apnea-hypopnea syndrom，OSAHS）患者的療效。
方法　計算機檢索PubMed（1990 ～ 2008.5）、中國期刊全文數據庫（1994 ～ 2008.5）、學術搜索引擎（1995 ～ 2008.4）、Springer Link（1997 ～ 2008），查找公開發表的評價CPAP 對OSAHS 患者生活質量影響的隨機對照試驗（RCT）和相關會議文獻及未發表的文章，試驗組采用CPAP 治療，對照組采用口服藥物或無效CPAP 治療。由2 名評價者按納入排除標準獨立選擇試驗，提取資料并交叉核對后進行方法學質量評估，而后運用RevMan 5.0 軟件進行Meta 分析。
結果　共納入15 個RCT，包括1 052 例患者。Meta 分析結果顯示：⑴ 總體結果：① ESS：CPAP 治療組與對照組相比，白天嗜睡程度明顯降低［WMD= – 2.61，95%CI（– 3.92， – 1.29）］；② MWT/ MSLT：CPAP 治療組清醒狀態維持時間比對照組有所延長，但差異無統計學意義［WMD=1.42，95%CI（– 0.01，2.85）］；⑵ 針對ESS 指標的亞組分析結果：① CPAP vs 基礎治療（鍛煉、減肥等）：CPAP 明顯降低OSAHS 患者的白天嗜睡程度［WMD= – 3.15，95%CI（– 4.84，– 1.47）］；② CPAP vs無效CPAP（安慰治療）：兩組間差異無統計學意義［WMD= – 2.39，95%CI（– 5.05，0.27）］；③ CPAP vs 口服藥物：CPAP 治療較口服藥物明顯降低了患者白天嗜睡的程度［WMD= – 1.97，95%CI（– 3.18，– 0.76）］。
結論　 CPAP 治療可明顯改善OSAHS 患者主觀感覺的白天嗜睡程度，但由于缺乏針對客觀指標MWT/ MSLT 的RCT，故未能進行亞組分析。總體而言，經過CPAP 治療后OSAHS 患者清醒狀態維持時間有所延長，但目前仍需多中心、大樣本的RCT 來進一步驗證CPAP 治療的有效性。另外，對治療時間長短導致的療效差異尚需進一步的研究證實。

引用本文： 葉紅,李濤平,馮媛,申海燕,劉愛華. 持續氣道正壓通氣治療對阻塞性睡眠呼吸暫停低通氣綜合征患者療效的系統評價. 中國循證醫學雜志, 2009, 09(10): 1067-1073. doi: 10.7507/1672-2531.20090189 復制

1.	中華醫學會呼吸病學分會睡眠呼吸疾病學組. 阻塞性睡眠呼吸暫停低通氣綜合征診治指南(草案). 中華結核和呼吸雜志, 2002, (04).
2.	Barbe F, Mayoralas LR, Duran J, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med, 2001, 134(11): 1015-1023.
3.	Marshall NS, Neill AM, Campbell AJ, et al. Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea. Thorax, 2005, 60(5): 427-432.
4.	Smith LA, Vennelle M, Gardner RS, et al. Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebocontrolled trial. Eur Heart J, 2007, 28(10): 1221-1227.
5.	Engleman HM, Kingshott RN, Wraith PK, et al. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med, 1999, 159(2): 461-467.
6.	Faccenda JF, Mackay TW, Boon NA, et al. Randomized placebocontrolled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med, 2001, 163(2): 344-348.
7.	Henke KG, Grady JJ, Kuna ST. Effect of nasal continuous positive airway pressure on neuropsychological function in sleep apneahypopnea syndrome. A randomized, placebo-controlled trial. Am J Respir Crit Care Med, 2001, 163(4): 911-917.
8.	Monasterio C, Vidal S, Duran J, et al. Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med, 2001, 164(6): 939-943.
9.	Barnes M, Mcevoy RD, Banks S, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med, 2004, 170(6): 656-664.
10.	Mansfield DR, Gollogly NC, Kaye DM, et al. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med, 2004, 169(3): 361-366.
11.	Robinson GV, Smith DM, Langford BA, et al. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J, 2006, 27(6): 1229-1235.
12.	Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, et al. Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest,2006, 129(6): 1459-1467.
13.	Ballester E, Badia JR, Hernandez L, et al. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med, 1999, 159(2): 495-501.
14.	Montserrat JM, Ferrer M, Hernandez L, et al. Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med, 2001, 164(4): 608-613.
15.	Lam B, Sam K, Mok WY, et al. Randomised study of three nonsurgical treatments in mild to moderate obstructive sleep apnoea. Thorax, 2007, 62(4): 354-359.
16.	Redline S, Adams N, Strauss ME, et al. Improvement of mild sleepdisordered breathing with CPAP compared with conservative therapy. Am J Respir Crit Care Med, 1998, 157(3 Pt 1): 858-865.
17.	Lojander J, Maasilta P, Partinen M, et al. Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study. Chest, 1996, 110(1): 114-119.
18.	Lojander J, Kajaste S, Maasilta P, et al. Cognitive function and treatment of obstructive sleep apnea syndrome. J Sleep Res, 1999, 8(1): 71-76.
19.	Yu BH, Ancoli-Israel S, Dimsdale JE. Effect of CPAP treatment on mood states in patients with sleep apnea. J Psychiatr Res, 1999, 33(5): 427-432.
20.	Phillips BA, Schmitt FA, Berry DT, et al. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest, 1990, 98(2): 325-330.
21.	Norman D, Loredo JS, Nelesen RA, et al. Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension, 2006, 47(5): 840-845.
22.	Kawahara S, Akashiba T, Akahoshi T, et al. Nasal CPAP improves the quality of life and lessens the depressive symptoms in patients with obstructive sleep apnea syndrome. Intern Med, 2005, 44(5): 422-427.
23.	Mazza S, Pepin JL, Naegele B, et al. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J, 2006, 28(5): 1020-1028.
24.	Antczak J, Popp R, Hajak G, et al. Positron emission tomography findings in obstructive sleep apnea patients with residual sleepiness treated with continuous positive airway pressure. J Physiol Pharmacol, 2007, 58 Suppl 5(Pt 1): 25-35.
25.	Neill AM, Wai HS, Bannan SP, et al. Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J, 2003, 22(2): 258-262.
26.	Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep, 2007, 30(6): 711-719.
27.	章志丹, 黃席珍. Epworth嗜睡評價量表與多次小睡潛伏時間試驗在評價白天嗜睡的相關性研究. 中國醫科大學學報, 2006, (03).

1. 中華醫學會呼吸病學分會睡眠呼吸疾病學組. 阻塞性睡眠呼吸暫停低通氣綜合征診治指南(草案). 中華結核和呼吸雜志, 2002, (04).
2. Barbe F, Mayoralas LR, Duran J, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med, 2001, 134(11): 1015-1023.
3. Marshall NS, Neill AM, Campbell AJ, et al. Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea. Thorax, 2005, 60(5): 427-432.
4. Smith LA, Vennelle M, Gardner RS, et al. Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebocontrolled trial. Eur Heart J, 2007, 28(10): 1221-1227.
5. Engleman HM, Kingshott RN, Wraith PK, et al. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med, 1999, 159(2): 461-467.
6. Faccenda JF, Mackay TW, Boon NA, et al. Randomized placebocontrolled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med, 2001, 163(2): 344-348.
7. Henke KG, Grady JJ, Kuna ST. Effect of nasal continuous positive airway pressure on neuropsychological function in sleep apneahypopnea syndrome. A randomized, placebo-controlled trial. Am J Respir Crit Care Med, 2001, 163(4): 911-917.
8. Monasterio C, Vidal S, Duran J, et al. Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med, 2001, 164(6): 939-943.
9. Barnes M, Mcevoy RD, Banks S, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med, 2004, 170(6): 656-664.
10. Mansfield DR, Gollogly NC, Kaye DM, et al. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med, 2004, 169(3): 361-366.
11. Robinson GV, Smith DM, Langford BA, et al. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J, 2006, 27(6): 1229-1235.
12. Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, et al. Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest,2006, 129(6): 1459-1467.
13. Ballester E, Badia JR, Hernandez L, et al. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med, 1999, 159(2): 495-501.
14. Montserrat JM, Ferrer M, Hernandez L, et al. Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med, 2001, 164(4): 608-613.
15. Lam B, Sam K, Mok WY, et al. Randomised study of three nonsurgical treatments in mild to moderate obstructive sleep apnoea. Thorax, 2007, 62(4): 354-359.
16. Redline S, Adams N, Strauss ME, et al. Improvement of mild sleepdisordered breathing with CPAP compared with conservative therapy. Am J Respir Crit Care Med, 1998, 157(3 Pt 1): 858-865.
17. Lojander J, Maasilta P, Partinen M, et al. Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study. Chest, 1996, 110(1): 114-119.
18. Lojander J, Kajaste S, Maasilta P, et al. Cognitive function and treatment of obstructive sleep apnea syndrome. J Sleep Res, 1999, 8(1): 71-76.
19. Yu BH, Ancoli-Israel S, Dimsdale JE. Effect of CPAP treatment on mood states in patients with sleep apnea. J Psychiatr Res, 1999, 33(5): 427-432.
20. Phillips BA, Schmitt FA, Berry DT, et al. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest, 1990, 98(2): 325-330.
21. Norman D, Loredo JS, Nelesen RA, et al. Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension, 2006, 47(5): 840-845.
22. Kawahara S, Akashiba T, Akahoshi T, et al. Nasal CPAP improves the quality of life and lessens the depressive symptoms in patients with obstructive sleep apnea syndrome. Intern Med, 2005, 44(5): 422-427.
23. Mazza S, Pepin JL, Naegele B, et al. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J, 2006, 28(5): 1020-1028.
24. Antczak J, Popp R, Hajak G, et al. Positron emission tomography findings in obstructive sleep apnea patients with residual sleepiness treated with continuous positive airway pressure. J Physiol Pharmacol, 2007, 58 Suppl 5(Pt 1): 25-35.
25. Neill AM, Wai HS, Bannan SP, et al. Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J, 2003, 22(2): 258-262.
26. Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep, 2007, 30(6): 711-719.
27. 章志丹, 黃席珍. Epworth嗜睡評價量表與多次小睡潛伏時間試驗在評價白天嗜睡的相關性研究. 中國醫科大學學報, 2006, (03).

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持續氣道正壓通氣治療對阻塞性睡眠呼吸暫停低通氣綜合征患者療效的系統評價

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《中國循證醫學雜志》

持續氣道正壓通氣治療對阻塞性睡眠呼吸暫停低通氣綜合征患者療效的系統評價

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