Abstract：
BACKGROUND: Obstructive sleep apnea (OSA) is a chronic disease with a high populational prevalence that is characterized as airway closure during sleep. Treatment is multidisciplinary and varies according to each case. Continuous positive airway pressure (CPAP), oral appliances, and surgery are the primary therapeutic options. Non-invasive conservative treatments such as sleep hygiene, positional therapy, physical exercises, and weight loss aim to reduce the worsening of the disease while being complementary to the invasive primary treatment.
OBJECTIVE: To analyze the impact of non-invasive conservative therapies on the clinical manifestations of OSA syndrome (OSA), compared with other interventions.
METHODS: This was a systematic review with meta-analysis. The searches were performed without filters for the time period, type of publication, or language. Randomized clinical trials on subjects over 18 years of age diagnosed with untreated OSA were included. Responses to non-invasive conservative treatment were compared with responses to the primary intervention. Primary outcomes were assessed using the Epworth Sleepiness Scale and/or Functional Outcomes of Sleep Questionnaire (FOSQ).
RESULTS: A total of eight studies were included in the review. The heterogeneity of the effect was estimated at 89.77%. Six studies compared conservative treatment with CPAP, one with oral appliances, and one with oropharyngeal exercises. Using the Epworth Sleepiness Scale measurements, the standardized difference in the estimated means, based on the random-effects model, was 0.457 (95% CI (1.082 to 0.169)) and the mean result did not differ significantly from zero (z = 1.43; p = 0.153). The conservative therapies assessed in this study improved the subjective quality of sleep, although the post-treatment ESE scores did not show significant results. The reduction in AHI and better outcomes in the evaluated domains, as well as in cognition and mood, were superior in the groups that received CPAP and IOD.
CONCLUSIONS: The most commonly used treatments of choice for OSA are invasive, including the use of CPAP, oral appliances, and surgeries, being the most utilized options. This study demonstrated that non-invasive conservative treatments, such as sleep hygiene, yield results as effective as invasive treatments. Further studies are needed to confirm this result and to predict whether invasive treatment can be used as the primary treatment or only as a supplement.
OBJECTIVE: To analyze the impact of non-invasive conservative therapies on the clinical manifestations of OSA syndrome (OSA), compared with other interventions.
METHODS: This was a systematic review with meta-analysis. The searches were performed without filters for the time period, type of publication, or language. Randomized clinical trials on subjects over 18 years of age diagnosed with untreated OSA were included. Responses to non-invasive conservative treatment were compared with responses to the primary intervention. Primary outcomes were assessed using the Epworth Sleepiness Scale and/or Functional Outcomes of Sleep Questionnaire (FOSQ).
RESULTS: A total of eight studies were included in the review. The heterogeneity of the effect was estimated at 89.77%. Six studies compared conservative treatment with CPAP, one with oral appliances, and one with oropharyngeal exercises. Using the Epworth Sleepiness Scale measurements, the standardized difference in the estimated means, based on the random-effects model, was 0.457 (95% CI (1.082 to 0.169)) and the mean result did not differ significantly from zero (z = 1.43; p = 0.153). The conservative therapies assessed in this study improved the subjective quality of sleep, although the post-treatment ESE scores did not show significant results. The reduction in AHI and better outcomes in the evaluated domains, as well as in cognition and mood, were superior in the groups that received CPAP and IOD.
CONCLUSIONS: The most commonly used treatments of choice for OSA are invasive, including the use of CPAP, oral appliances, and surgeries, being the most utilized options. This study demonstrated that non-invasive conservative treatments, such as sleep hygiene, yield results as effective as invasive treatments. Further studies are needed to confirm this result and to predict whether invasive treatment can be used as the primary treatment or only as a supplement.
摘要：
背景：阻塞性睡眠呼吸暂停（OSA）是一种慢性疾病，具有高人群患病率，其特征为睡眠期间的气道闭合。治疗是多学科的，根据每个病例而有所不同。持续气道正压通气(CPAP),口腔矫治器,手术是主要的治疗选择。非侵入性保守治疗，如睡眠卫生，位置疗法,体育锻炼,减肥旨在减少疾病的恶化，同时补充侵入性初级治疗。
目的：分析非侵入性保守治疗对OSA综合征（OSA）临床表现的影响，与其他干预措施相比。
方法：这是一个系统评价与荟萃分析。搜索是在没有过滤器的情况下执行的，出版物类型,或语言。包括对18岁以上被诊断患有未经治疗的OSA的受试者的随机临床试验。将对非侵入性保守治疗的反应与对主要干预的反应进行比较。使用Epworth嗜睡量表和/或睡眠功能结果问卷（FOSQ）评估主要结果。
结果：共8项研究纳入本综述。效应的异质性估计为89.77%。六项研究比较了保守治疗与CPAP，一个用口腔矫治器，还有一个口咽锻炼。使用Epworth嗜睡量表测量，估计均值的标准化差异，基于随机效应模型，为0.457（95％CI（1.082至0.169）），平均结果与零没有显着差异（z=1.43；p=0.153）。本研究评估的保守疗法改善了主观睡眠质量，尽管治疗后的ESE评分没有显著结果.AHI的减少和评估领域的更好结果，以及认知和情绪，在接受CPAP和IOD的组中优于。
结论：OSA最常用的治疗方法是侵入性，包括CPAP的使用，口腔矫治器,和手术，是最常用的选项。这项研究表明，非侵入性保守治疗，如睡眠卫生，产量结果与侵入性治疗一样有效。需要进一步的研究来证实这一结果，并预测侵入性治疗是否可以用作主要治疗还是仅作为补充。
目的：分析非侵入性保守治疗对OSA综合征（OSA）临床表现的影响，与其他干预措施相比。
方法：这是一个系统评价与荟萃分析。搜索是在没有过滤器的情况下执行的，出版物类型,或语言。包括对18岁以上被诊断患有未经治疗的OSA的受试者的随机临床试验。将对非侵入性保守治疗的反应与对主要干预的反应进行比较。使用Epworth嗜睡量表和/或睡眠功能结果问卷（FOSQ）评估主要结果。
结果：共8项研究纳入本综述。效应的异质性估计为89.77%。六项研究比较了保守治疗与CPAP，一个用口腔矫治器，还有一个口咽锻炼。使用Epworth嗜睡量表测量，估计均值的标准化差异，基于随机效应模型，为0.457（95％CI（1.082至0.169）），平均结果与零没有显着差异（z=1.43；p=0.153）。本研究评估的保守疗法改善了主观睡眠质量，尽管治疗后的ESE评分没有显著结果.AHI的减少和评估领域的更好结果，以及认知和情绪，在接受CPAP和IOD的组中优于。
结论：OSA最常用的治疗方法是侵入性，包括CPAP的使用，口腔矫治器,和手术，是最常用的选项。这项研究表明，非侵入性保守治疗，如睡眠卫生，产量结果与侵入性治疗一样有效。需要进一步的研究来证实这一结果，并预测侵入性治疗是否可以用作主要治疗还是仅作为补充。
