口腔矯正器和持續正壓氣道通氣治療輕中度OSAHS療效比較的Meta分析_《中國循證醫學雜志》

作者：

王念 ¹ , 涂學平 ¹ ,  胡克 ¹ , 肖錦秀 ¹ , 郭毅 ²

1. 武漢大學人民醫院（武漢 430060）；2. 武漢大學公共衛生學院流行病學教研室（武漢 430071）;

關鍵詞：

口腔矯正器持續氣道正壓通氣阻塞性睡眠呼吸暫停低通氣綜合征系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130039

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價口腔矯正器和持續正壓氣道通氣比較治療輕中度睡眠呼吸暫停低通氣綜合征（OSAHS）的療效。
方法　計算機檢索PubMed、EMbase、The Cochrane Library、CBM、VIP、WanFang Data及CNKI，查找公開發表及未發表的有關口腔矯正器（OA）和持續正壓氣道通氣（CPAP）比較治療OSAHS療效的隨機對照試驗（RCT），檢索時限均為建庫至2012年11月30日，并查找相關會議論文文獻，文種和發表時間不限。由2位評價者根據納入與排除標準獨立篩選文獻，提取資料并評價質量后，采用RevMan 5.1軟件進行Meta分析，并采用GRADEpro 3.6軟件評價證據質量。
結果　最終納入7個RCT。Meta分析結果顯示：① CPAP在改善輕中度OSAHS患者睡眠呼吸暫停低通氣指數的作用更顯著，其差異具有統計學意義［WMD=9.13，95%CI（8.77，9.50），P lt;0.000 01］；② OA和CPAP在改善輕中度OSAHS患者主觀白天嗜睡方面，差異無統計學意義［WMD=0.00，95%CI（?0.12，0.12），P=0.97］。
結論　與OA相比，CPAP在改善輕中度OSAHS患者睡眠呼吸暫停低通氣指數的作用更顯著，但在改善患者主觀白天嗜睡方面無顯著差異。受納入研究質量與數量所限，上述結論尚需開展更多高質量RCT加以驗證。

引用本文： 王念,涂學平,胡克,肖錦秀,郭毅. 口腔矯正器和持續正壓氣道通氣治療輕中度OSAHS療效比較的Meta分析. 中國循證醫學雜志, 2013, 13(2): 231-235. doi: 10.7507/1672-2531.20130039 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, 25(4): 195-198.
2.	Lim J, Lasserson T J, Fleetham J, et al. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev, 2004, (4): D4435.
3.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011].The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
4.	Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ (Clinical research ed.), 2004, 328(7454): 1490.
5.	Ferguson KA, Ono T, Lowe AA, et al. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest, 1996, 109(5): 1269-1275.
6.	Ferguson KA, Ono T, Lowe AA, et al. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax, 1997, 52(4): 362-368.
7.	Randerath WJ, Heise M, Hinz R, et al. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest, 2002, 122(2): 569-575.
8.	Tan YK, L’Estrange PR, Luo YM, et al. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Eur J Orthod, 2002, 24(3): 239-249.
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.	Aarab G, Lobbezoo F, Heymans MW, et al. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration, 2011, 82(2): 162-168.
11.	Aarab G, Lobbezoo F, Hamburger HL, et al. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration, 2011, 81(5): 411-419.
12.	Giles TL, Lasserson TJ, Smith BH, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev, 2006, 3: D1106.
13.	葉紅, 李濤平, 馮媛, 等. 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, 9(10): 1067-1073.
14.	Marshall NS, Barnes M, Travier N, et al. Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis. Thorax, 2006, 61(5): 430-434.
15.	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, 35(3): 324.

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, 25(4): 195-198.
2. Lim J, Lasserson T J, Fleetham J, et al. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev, 2004, (4): D4435.
3. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011].The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
4. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ (Clinical research ed.), 2004, 328(7454): 1490.
5. Ferguson KA, Ono T, Lowe AA, et al. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest, 1996, 109(5): 1269-1275.
6. Ferguson KA, Ono T, Lowe AA, et al. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax, 1997, 52(4): 362-368.
7. Randerath WJ, Heise M, Hinz R, et al. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest, 2002, 122(2): 569-575.
8. Tan YK, L’Estrange PR, Luo YM, et al. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Eur J Orthod, 2002, 24(3): 239-249.
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. Aarab G, Lobbezoo F, Heymans MW, et al. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration, 2011, 82(2): 162-168.
11. Aarab G, Lobbezoo F, Hamburger HL, et al. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration, 2011, 81(5): 411-419.
12. Giles TL, Lasserson TJ, Smith BH, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev, 2006, 3: D1106.
13. 葉紅, 李濤平, 馮媛, 等. 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, 9(10): 1067-1073.
14. Marshall NS, Barnes M, Travier N, et al. Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis. Thorax, 2006, 61(5): 430-434.
15. 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, 35(3): 324.

《中國循證醫學雜志》

口腔矯正器和持續正壓氣道通氣治療輕中度OSAHS療效比較的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國循證醫學雜志》

口腔矯正器和持續正壓氣道通氣治療輕中度OSAHS療效比較的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料