PDF(Pubmed)
Abstract：
Obstructive sleep apnea (OSA) is a recurrent partial or complete obstruction of the upper airway during sleep caused by narrowing or collapse of the pharyngeal wall. It leads to microstimulation and oxyhemoglobin desaturation, resulting in sleepiness and loud snoring. OSA negatively affects the cardiovascular system and may contribute to neurocognitive impairment. The aim of this systematic review is to evaluate the effectiveness and efficacy of appliance therapy in obstructive sleep apnea. The effectiveness was assessed by using the Apnea Hypopnea Index (AHI). An electronic search of the Cochrane Library, PubMed, and Google Scholar was conducted between 1998 and 2021. Articles were independently assessed by three reviewers. The quality of a randomised control trial (RCT) is assessed using the Cochrane risk of bias method. The tool GRADE was used to achieve the desired level of confidence for each outcome reported. Several studies used continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), and tongue retention devices (TRD). The meta-analysis included a total of six papers that met the inclusion criteria. Results showed that CPAP significantly improved AHI compared with an oral appliance (random effects: difference in means = 8.40, 95% CI = 7.21 to 9.60). It was also found that oral appliance (OA) therapy significantly improved AHI compared with baseline before appliance therapy (random effects: mean difference = 13.40, 95% CI = 10.87 to 15.93; p.00001). For mild to moderate OSA, CPAP is considered the gold standard. Our meta-analysis of six RCTs found favorable evidence for OSA patients receiving oral devices; however, they were less effective than CPAP. A subgroup analysis found that MAD may be a beneficial treatment for mild to moderate OSA patients who do not respond to CPAP. The findings suggest that oral appliances may be an effective treatment for OSA, especially in patients with mild to moderate OSA.
摘要：
阻塞性睡眠呼吸暂停(OSA)是在睡眠期间由咽壁变窄或塌陷引起的上气道的复发性部分或完全阻塞。它导致微刺激和氧合血红蛋白去饱和，导致困倦和大声打鼾。OSA会对心血管系统产生负面影响，并可能导致神经认知障碍。这项系统评价的目的是评估矫治器治疗阻塞性睡眠呼吸暂停的有效性和功效。通过使用呼吸暂停低通气指数(AHI)评估有效性。对Cochrane图书馆的电子搜索，PubMed,GoogleScholar是在1998年至2021年之间进行的。文章由三名审稿人独立评估。使用Cochrane偏倚风险方法评估随机对照试验（RCT）的质量。使用GRADE工具来实现所报告的每个结果的所需置信水平。几项研究使用持续气道正压通气（CPAP），下颌前移装置（MAD），和舌头保持装置（TRD）。荟萃分析共纳入6篇符合纳入标准的论文。结果表明，与口腔矫治器相比，CPAP显着改善了AHI（随机效应：均值差异=8.40，95％CI=7.21至9.60）。还发现，与矫治器治疗前的基线相比，口腔矫治器（OA）治疗显着改善了AHI（随机效应：平均差异=13.40，95％CI=10.87至15.93；p.00001）。对于轻度至中度OSA，CPAP被认为是黄金标准。我们对六个随机对照试验的荟萃分析发现了OSA患者接受口腔器械的有利证据；然而，效果不如CPAP。亚组分析发现，MAD可能是对CPAP无反应的轻度至中度OSA患者的有益治疗方法。研究结果表明，口腔矫治器可能是OSA的有效治疗方法，尤其是轻度至中度OSA患者。
