Journal
SLEEP MEDICINE
Volume 30, Issue -, Pages 7-14Publisher
ELSEVIER
DOI: 10.1016/j.sleep.2016.06.001
Keywords
Network meta-analysis; Aerobic exercise training; Mandibular advancement device; Continuous positive airway pressure; Dietary weight loss
Categories
Funding
- NIH for Phenotyping and OSA
- ResMed to study OSA/CSA
- CPAP
- Jazz clinical trial for EDS in OSA
- Inspire post-marketing clinical trial
- Apnicure
- Foramis Medical Group
- CryOSA
- ResMed Inc.
- ResMed
- SomnoMed
- Zephyr Sleep Technologies
- Fisher
- Paykel
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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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