Comparative efficacy of CPAP, MADs, exercise-training, and dietary weight loss for sleep apnea: a network meta-analysis

被引：101
作者：
Iftikhar, Imran H. [1 ]
Bittencourt, Lia [2 ]
Youngstedt, Shawn D. [3 ]
Ayas, Najib [4 ]
Cistulli, Peter [5 ]
Schwab, Richard [6 ]
Durkin, Martin W. [7 ]
Magalang, Ulysses J. [8 ]
机构：
[1] Emory Univ, Div Pulm Allergy, Crit Care Sleep Med, 615 Michael St, Atlanta, GA USA
[2] Univ Fed S ao Paulo UNIFESP, Dept Psicobiologia, S ao Paulo, SP, Brazil
[3] Arizona State Univ, Coll Nursing & Hlth Innovat, Phoenix, AZ USA
[4] Univ British Columbia, Dept Med, Vancouver, BC, Canada
[5] Univ Sydney, Sydney Med Sch, Royal North Shore Hosp, Dept Resp & Sleep Med, Sydney, NSW, Australia
[6] Univ Pennsylvania Med Ctr, Div Sleep Med, Dept Med, Pulm, Philadelphia, PA USA
[7] Dept Clin Res, Palmetto Hlth Richland, Columbia, SC USA
[8] Ohio State Univ Wexner Med Ctr, Div Pulm, Allergy, Crit care Sleep Med, Columbus, OH USA
来源：
SLEEP MEDICINE | 2017年 / 30卷
关键词：
Network meta-analysis; Aerobic exercise training; Mandibular advancement device; Continuous positive airway pressure; Dietary weight loss; POSITIVE AIRWAY PRESSURE; PLACEBO-CONTROLLED TRIAL; ORAL APPLIANCE THERAPY; CHRONIC HEART-FAILURE; MANDIBULAR ADVANCEMENT DEVICES; RANDOMIZED CONTROLLED-TRIAL; QUALITY-OF-LIFE; BLOOD-PRESSURE; RESISTANT HYPERTENSION; DAYTIME FUNCTION;
D O I：
10.1016/j.sleep.2016.06.001
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
Study objective: To synthesize evidence from available studies on the relative efficacies of continuous positive airway pressure (CPAP), mandibular advancement device (MAD), supervised aerobic exercise training, and dietary weight loss in patients with obstructive sleep apnea (OSA). Design: Network meta-analysis of 80 randomized controlled trials (RCTs) short-listed from PubMed, SCOPUS, Web of science, and Cochrane register (inception - September 8, 2015). Patients: Individuals with OSA. Interventions: CPAP, MADs, exercise training, and dietary weight loss. Results: CPAP decreased apnea-hypopnea index (AHI) the most [by 25.27 events/hour (22.03-28.52)] followed by exercise training, MADs, and dietary weight loss. While the difference between exercise training and CPAP was non-significant [-8.04 (-17.00 to 0.92), a significant difference was found between CPAP and MADs on AHI and oxygen desaturation index (ODI) [-10.06 (-14.21 to - 5.91) and - 7.82 (- 13.04 to - 2.59), respectively]. Exercise training significantly improved Epworth sleepiness scores (ESS) [by 3.08 (0.68-5.48)], albeit with a non-significant difference compared to MADs and CPAP. Conclusions: CPAP is the most efficacious in complete resolution of sleep apnea and in improving the indices of saturation during sleep. While MADs offer a reasonable alternative to CPAP, exercise training which significantly improved daytime sleepiness (ESS) could be used as adjunctive to the former two. (C) 2016 Elsevier B.V. All rights reserved.
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页码：7 / 14
页数：8
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