期刊
SLEEP MEDICINE REVIEWS
卷 27, 期 -, 页码 108-124出版社
W B SAUNDERS CO LTD
DOI: 10.1016/j.smrv.2015.05.003
关键词
Meta-analysis; Obstructive sleep apnoea-hypopnoea; Mandibular advancement device; Continuous positive airway pressure
资金
- National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme [08/110/03, ISRCTN02309506]
- National Institute of Health Research, Clinical Trials Methodology fellowship
- MRC [MC_UU_00002/3, MC_U105232027, MC_UP_1302/2] Funding Source: UKRI
- Medical Research Council [MC_UP_1302/2, MC_UU_00002/3, MC_U105232027] Funding Source: researchfish
Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness, impairs quality-of-life, and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment and mandibular advancement devices (MAD) have been shown to be effective in individual trials but their effectiveness particularly relative to disease severity is unclear. A MEDLINE, Embase and Science Citation Index search updating two systematic reviews to August 2013 identified 77 RCTs in adult OSAH patients comparing: MAD with conservative management (CM); MAD with CPAP; or CPAP with CM. Overall MAD and CPAP significantly improved apnoea-hypopnoea index (AHI) (MAD -9.3/hr (p < 0.001), CPAP -25.4 (p < 0.001)). In direct comparisons mean AHI and Epworth sleepiness scale score were lower (7.0/hr (p < 0.001) and 0.67 (p = 0.093) respectively) for CPAP. There were no CPAP vs. MAD trials in mild OSAH but in comparisons with CM, MAD and CPAP reduced ESS similarly (MAD 2.01 (p < 0.001); CPAP 1.23 (p = 0.012). Both MAD and CPAP are clinically effective in the treatment of OSAH. Although CPAP has a greater treatment effect, MAD is an appropriate treatment for patients who are intolerant of CPAP and may be comparable to CPAP in mild disease. Crown Copyright (C) 2015 Published by Elsevier Ltd.
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