Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment

被引:486
作者
Patil, Susheel P. [1 ]
Ayappa, Indu A. [2 ]
Caples, Sean M. [3 ]
Kimoff, R. John [4 ]
Patel, Sanjay R. [5 ]
Harrod, Christopher G. [6 ]
机构
[1] Johns Hopkins Univ, Baltimore, MD USA
[2] Icahn Sch Med Mt Sinai, New York, NY 10029 USA
[3] Mayo Clin, Rochester, MN USA
[4] McGill Univ, Ctr Hlth, Montreal, PQ, Canada
[5] Univ Pittsburgh, Pittsburgh, PA USA
[6] Amer Acad Sleep Med, Darien, IL USA
来源
JOURNAL OF CLINICAL SLEEP MEDICINE | 2019年 / 15卷 / 02期
关键词
obstructive sleep apnea; OSA; positive airway pressure; PAP; RANDOMIZED CONTROLLED-TRIAL; QUALITY-OF-LIFE; CORONARY-ARTERY-DISEASE; MINIMAL IMPORTANT DIFFERENCE; CARDIOVASCULAR RISK-FACTORS; AMBULATORY BLOOD-PRESSURE; PLACEBO-CONTROLLED TRIAL; HEART-FAILURE PATIENTS; IN-HOME TREATMENT; CPAP THERAPY;
D O I
10.5664/jcsm.7638
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Introduction: The purpose of this systematic review is to provide supporting evidence for the clinical practice guideline for the treatment of obstructive sleep apnea (OSA) in adults using positive airway pressure (PAP). Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of PAP with no treatment as well as studies that compared different PAP modalities. Meta-analyses were performed to determine the clinical significance of using PAP in several modalities (ie, continuous PAP, auto-adjusting PAP, and bilevel PAP), to treat OSA in adults. In addition, meta-analyses were performed to determine the clinical significance of using an in-laboratory versus ambulatory strategy for the initiation of PAP, educational and behavioral interventions, telemonitoring, humidification, different mask interfaces, and flexible or modified pressure profile PAP in conjunction with PAP to treat OSA in adults. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. Results: The literature search resulted in 336 studies that met inclusion criteria; 184 studies provided data suitable for meta-analyses. The data demonstrated that PAP compared to no treatment results in a clinically significant reduction in disease severity, sleepiness, blood pressure, and motor vehicle accidents, and improvement in sleep-related quality of life in adults with OSA. In addition, the initiation of PAP in the home demonstrated equivalent effects on patient outcomes when compared to an in-laboratory titration approach. The data also demonstrated that the use of auto-adjusting or bilevel PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP. Furthermore, data demonstrated a clinically significant improvement in PAP adherence with the use of educational, behavioral, troubleshooting, and telemonitoring interventions. Systematic reviews for specific PAP delivery method were also performed and suggested that nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity, heated humidification compared to no humidification reduces some continuous PAP-related side effects, and pressure profile PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP.
引用
收藏
页码:301 / 334
页数:34
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