口腔矫治器和持续正压气道通气对于OSAHS患者疗效的Meta分析被引量：2

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摘要目的Meta分析比较口腔矫治器（OA）和持续正压气道通气（CPAP）治疗阻塞睡眠呼吸暂停低通气综合征（OSAHS）的疗效。方法计算机检索以下数据库：PubMed，ISI Web of Knowledge，Ovid，EBSCO Dentistry＆Oral Science Source，Cochrane Library，Embase，CBM，CNKI，WanFangData，纳入有关于比较OA和CPAP治疗OSAHS患者疗效的随机对照试验（RCT）。检索时间截止为20154-11月20日。采用RevMan5．2软件进行Meta分析。结果最终纳入18个RCT进行定性分析，其中16个RCT进行定量分析（meta分析）。Meta分析结果显示：CPAP较OA更能有效降低OSAHS患者的睡眠呼吸暂停低通气指数（AHI），增加中度亚组患者最低动脉血氧饱和度（miniSaO2）（P〈0．05）；平行试验组中度亚组CPAP较OA更能降低ESS评分（P〈0．05），其余各组ESS评分、miniSa02以及觉醒指数（ARI）、REM％、FOSQ评分相当（P〉0．05）。定性分析结果显示：患者更倾向于OA治疗。结论CPAP较OA更能改善OSAHS患者客观病情程度。但在主观白天嗜睡情况、夜间睡眠状况、生存质量和血压方面，两者无明显差异，其中OA治疗在改善重度患者夜间睡眠状态效果更佳，CPAP治疗改善中度患者夜间睡眠状态效果更佳。患者更倾向于OA治疗。 Objective To conduct a meta-analysis of studies which have compared the effectiveness of oral appliance （ OA ） with continuous positive airway pressure （ CPAP ） in treating patients with obstructive sleep apnea-hypopnea syndrome （ OSAHS ） . Methods Studies were retrieved by searching PubMed, ISI Web of Knowledge, Ovid, EBSCO Dentistry ＆ Oral Science Source, Cochrane Library, Embase, CBM, CNKI, WanFang Data （all studies that were published until November 20, 2015 ） , and only randomized controlled trial （RCT） were included based on the inclusion and exclusion criteria. And then a meta-analysis was performed using RevMan 5.2 software. Results A total of 18 RCTs were included in qualitative synthesis, with 16 of them included in quantitative synthesis （ meta-analysis ） . The results showed that： AHI decreased significantly in all groups compared with OA, CPAP, and mini SaO2 in moderate group （P〈0.05） .No significant difference was showed in ARI, REM%, FOSQ in all groups, and in ESS for OSAHS patients with OA or CPAP （ P〉0.05 ） , with the exception of ESS decline in moderate group for CPAP （ P〈0.05 ） . Anyway OA shared greater preference. Conclusion According to the accessible evidences, CPAP incredibly decreases OSAHS severity. There is no differences in improving daytime sleepiness, night sleeping status and quality of life, but for larger sleep improving in severe group with OA treatment and in moderate group with CPAP. However, the OSAHS patients prefer OA during the treating period.