口腔矫正器和持续正压气道通气治疗轻中度OSAHS疗效比较的Meta分析_《中国循证医学杂志》

作者：

王念 ¹ , 涂学平 ¹ ,  胡克 ¹ , 肖锦秀 ¹ , 郭毅 ²

1. 武汉大学人民医院（武汉 430060）；2. 武汉大学公共卫生学院流行病学教研室（武汉 430071）;

关键词：

口腔矫正器持续气道正压通气阻塞性睡眠呼吸暂停低通气综合征系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20130039

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价口腔矫正器和持续正压气道通气比较治疗轻中度睡眠呼吸暂停低通气综合征（OSAHS）的疗效。
方法　计算机检索PubMed、EMbase、The Cochrane Library、CBM、VIP、WanFang Data及CNKI，查找公开发表及未发表的有关口腔矫正器（OA）和持续正压气道通气（CPAP）比较治疗OSAHS疗效的随机对照试验（RCT），检索时限均为建库至2012年11月30日，并查找相关会议论文文献，文种和发表时间不限。由2位评价者根据纳入与排除标准独立筛选文献，提取资料并评价质量后，采用RevMan 5.1软件进行Meta分析，并采用GRADEpro 3.6软件评价证据质量。
结果　最终纳入7个RCT。Meta分析结果显示：① CPAP在改善轻中度OSAHS患者睡眠呼吸暂停低通气指数的作用更显著，其差异具有统计学意义［WMD=9.13，95%CI（8.77，9.50），P lt;0.000 01］；② OA和CPAP在改善轻中度OSAHS患者主观白天嗜睡方面，差异无统计学意义［WMD=0.00，95%CI（−0.12，0.12），P=0.97］。
结论　与OA相比，CPAP在改善轻中度OSAHS患者睡眠呼吸暂停低通气指数的作用更显著，但在改善患者主观白天嗜睡方面无显著差异。受纳入研究质量与数量所限，上述结论尚需开展更多高质量RCT加以验证。

引用本文： 王念,涂学平,胡克,肖锦秀,郭毅. 口腔矫正器和持续正压气道通气治疗轻中度OSAHS疗效比较的Meta分析. 中国循证医学杂志, 2013, 13(2): 231-235. doi: 10.7507/1672-2531.20130039 复制

1.	中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案). 中华结核和呼吸杂志, 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.	叶红, 李涛平, 冯媛, 等. 持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者疗效的系统评价. 中国循证医学杂志, 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, 黄席珍. Epworth嗜睡评价量表与多次小睡潜伏时间试验在评价白天嗜睡的相关性研究. 中国医科大学学报, 2006, 35(3): 324.

1. 中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案). 中华结核和呼吸杂志, 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. 叶红, 李涛平, 冯媛, 等. 持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者疗效的系统评价. 中国循证医学杂志, 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, 黄席珍. Epworth嗜睡评价量表与多次小睡潜伏时间试验在评价白天嗜睡的相关性研究. 中国医科大学学报, 2006, 35(3): 324.

《中国循证医学杂志》

口腔矫正器和持续正压气道通气治疗轻中度OSAHS疗效比较的Meta分析

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《中国循证医学杂志》

口腔矫正器和持续正压气道通气治疗轻中度OSAHS疗效比较的Meta分析

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