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Abstract：
OBJECTIVE: Randomized controlled trials have shown that combining norepinephrine reuptake inhibitors and antimuscarinics can ameliorate the severity of obstructive sleep apnea. This article explores whether the effectiveness and safety of combining norepinephrine reuptake inhibitors with antimuscarinic agents surpass monotherapy for treating obstructive sleep apnea.
METHODS: We searched randomized controlled trials including adult patients with obstructive sleep apnea who received combination therapy and monotherapy in 8 databases from inception until April 5, 2023 and evaluated the studies\' quality and conducted a meta-analysis and systematic review. The primary outcome was the apnea-hypopnea index. Secondary outcome measures included loop gain, hypoxic burden, oxygen desaturation index, and ventilation at low ventilatory drive, among other indicators. We assessed the quality of the studies using Cochrane Methods criteria.
RESULTS: We identified 4 randomized controlled trials for systematic review and 2 for meta-analysis. The results of the meta-analysis showed that norepinephrine reuptake inhibitors combined with antimuscarinic agents in patients with obstructive sleep apnea prolonged total sleep time by a mean of 28.20 minutes [95% confidence interval (5.78, 50.61), P = .01] and increased sleep efficiency by 4.73% [95% confidence interval (0.50, 8.97), P = .03] compared with norepinephrine reuptake inhibitors alone. Other indices and adverse events were of no statistical significance. The systematic reviews revealed that norepinephrine reuptake inhibitors combined with antimuscarinics may be superior to monotherapy in improving apnea-hypopnea index and endotypic traits.
CONCLUSIONS: This evaluation demonstrated the potential advantages of combining norepinephrine reuptake inhibitors plus antimuscarinics for treating OSA compared with norepinephrine reuptake inhibitors alone and revealed no statistically significant difference in drug safety.
BACKGROUND: Wang J, Ye Y, Shang Z, et al. Effect of norepinephrine reuptake inhibitors combined with antimuscarinic agents vs monotherapy for OSA: a systematic review and meta-analysis. J Clin Sleep Med. 2024;20(8):1363-1372.
METHODS: We searched randomized controlled trials including adult patients with obstructive sleep apnea who received combination therapy and monotherapy in 8 databases from inception until April 5, 2023 and evaluated the studies\' quality and conducted a meta-analysis and systematic review. The primary outcome was the apnea-hypopnea index. Secondary outcome measures included loop gain, hypoxic burden, oxygen desaturation index, and ventilation at low ventilatory drive, among other indicators. We assessed the quality of the studies using Cochrane Methods criteria.
RESULTS: We identified 4 randomized controlled trials for systematic review and 2 for meta-analysis. The results of the meta-analysis showed that norepinephrine reuptake inhibitors combined with antimuscarinic agents in patients with obstructive sleep apnea prolonged total sleep time by a mean of 28.20 minutes [95% confidence interval (5.78, 50.61), P = .01] and increased sleep efficiency by 4.73% [95% confidence interval (0.50, 8.97), P = .03] compared with norepinephrine reuptake inhibitors alone. Other indices and adverse events were of no statistical significance. The systematic reviews revealed that norepinephrine reuptake inhibitors combined with antimuscarinics may be superior to monotherapy in improving apnea-hypopnea index and endotypic traits.
CONCLUSIONS: This evaluation demonstrated the potential advantages of combining norepinephrine reuptake inhibitors plus antimuscarinics for treating OSA compared with norepinephrine reuptake inhibitors alone and revealed no statistically significant difference in drug safety.
BACKGROUND: Wang J, Ye Y, Shang Z, et al. Effect of norepinephrine reuptake inhibitors combined with antimuscarinic agents vs monotherapy for OSA: a systematic review and meta-analysis. J Clin Sleep Med. 2024;20(8):1363-1372.
摘要：
目的：随机对照试验表明，联合使用去甲肾上腺素再摄取抑制剂和抗毒蕈碱类药物可以改善阻塞性睡眠呼吸暂停（OSA）的严重程度。本文探讨了去甲肾上腺素再摄取抑制剂与抗毒蕈碱药物联合治疗OSA的有效性和安全性是否超过单一疗法。
方法：我们检索了从开始到2023年4月5日在八个数据库中接受联合和单一疗法的成年OSA患者的随机对照试验（RCT），然后评估了纳入的研究的质量，并进行了荟萃分析和系统评价。主要结果是呼吸暂停低通气指数（AHI）。次要结果指标包括环路增益，低氧负荷,氧饱和度指数,和Vpassive，在其他指标中。我们使用Cochrane方法标准评估了研究的质量。
结果：确定四个RCT用于系统评价，两个用于荟萃分析。荟萃分析结果显示,去甲肾上腺素再摄取抑制剂联合抗毒蕈碱类药物使OSA患者总睡眠时间平均延长28.20min[95%CI(5.78,50.61),P=0.01],睡眠效率提高4.73%[95CI（0.50，8.97），P=0.03]与单独去甲肾上腺素再摄取抑制剂相比。其他指标和不良事件均无统计学意义。系统评价显示，去甲肾上腺素再摄取抑制剂与抗毒蕈药联合使用在改善AHI和内生性状方面可能优于单一疗法。
结论：本文证明了去甲肾上腺素再摄取抑制剂联合抗毒蕈药治疗OSA的潜在优势，与单独的去甲肾上腺素再摄取抑制剂相比，并显示无统计学意义的安全性。
方法：我们检索了从开始到2023年4月5日在八个数据库中接受联合和单一疗法的成年OSA患者的随机对照试验（RCT），然后评估了纳入的研究的质量，并进行了荟萃分析和系统评价。主要结果是呼吸暂停低通气指数（AHI）。次要结果指标包括环路增益，低氧负荷,氧饱和度指数,和Vpassive，在其他指标中。我们使用Cochrane方法标准评估了研究的质量。
结果：确定四个RCT用于系统评价，两个用于荟萃分析。荟萃分析结果显示,去甲肾上腺素再摄取抑制剂联合抗毒蕈碱类药物使OSA患者总睡眠时间平均延长28.20min[95%CI(5.78,50.61),P=0.01],睡眠效率提高4.73%[95CI（0.50，8.97），P=0.03]与单独去甲肾上腺素再摄取抑制剂相比。其他指标和不良事件均无统计学意义。系统评价显示，去甲肾上腺素再摄取抑制剂与抗毒蕈药联合使用在改善AHI和内生性状方面可能优于单一疗法。
结论：本文证明了去甲肾上腺素再摄取抑制剂联合抗毒蕈药治疗OSA的潜在优势，与单独的去甲肾上腺素再摄取抑制剂相比，并显示无统计学意义的安全性。
