该研究旨在评估阻塞性睡眠呼吸暂停患者下颌前移装置(MAD)降低24小时平均血压的效果。睡眠质量,呼吸暂停低通气指数(AHI),和患者的依从性,与持续气道正压通气(CPAP)相比,其他干预措施,或者没有治疗。三个不同的数据库,如PubMed,EMBASE,根据纳入和排除标准,在2021年7月之前使用不同的搜索词对CENTRAL进行搜索。纳入研究后,进行数据提取,包括偏倚风险评估。对于每一项研究,我们用了赔率比,平均差异,和95%的置信区间来评估和综合结果。根据建议分级评估证据质量,评估,发展,和评估(等级)。纳入21项随机对照试验:MAD组497例患者,CPAP组239例,假手术组274名患者。在MAD-CPAP比较中,结果有利于CPAP的AHI降低3.48(1.76-5.19)。然而,用Epworth嗜睡量表(ESS)测量的睡眠质量结果不清楚,患者依从性,和24小时平均血压。在MAD-sham比较中,结果有利于MAD的AHI降低-8.39(-10.90--5.88]和ESS降低-0.91(-1.70--0.12),而有利于假在患者依从性方面,24小时平均血压的结果不清楚。等级分数表明证据质量很低,低,对于不同的结果是适度的。与MAD相比的CPAP和与假手术相比的MAD显示出显著的AHI降低。然而,MAD-CPAP或MAD-sham患者的依从性和24小时平均血压无显著差异.将MAD与CPAP和假手术进行比较时,证据质量非常低,分别,对于AHI。
The study aimed to assess the effect of mandibular advancement device (MAD) in patients with obstructive sleep apnea for reduction in 24-h mean blood pressure, sleep quality, Apnea Hypopnea Index (AHI), and patient compliance, compared to continuous positive airway pressure (CPAP), other interventions, or no treatment. Three different databases such as PubMed, EMBASE, and CENTRAL were searched using different search terms till July 2021 as per the inclusion and exclusion criteria. After inclusion of studies, data extraction including risk of bias assessment was done. For each study, we used odds ratio, mean difference, and 95% confidence interval to assess and synthesize the outcomes. The quality of evidence was evaluated as per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Twenty-one randomized controlled trials were included: 497 patients in the MAD group, 239 patients in the CPAP group, and 274 patients in the sham group. In MAD-CPAP comparison, the results favored CPAP in the reduction of AHI of 3.48 (1.76-5.19). However, unclear results were found for sleep quality measured as Epworth Sleepiness Scale (ESS), patient compliance, and 24-h mean blood pressure. In MAD-sham comparison, the results favored MAD in the reduction of AHI of - 8.39 (-10.90--5.88] and ESS of - 0.91 (-1.70--0.12) and favored sham in terms of patient compliance while, unclear results for 24-h mean blood pressure. The GRADE score indicated that the quality of evidence is very low, low, and moderate for different outcomes. CPAP in comparison to MAD and MAD in comparison to sham showed a significant AHI reduction. However, patient compliance and 24-h mean blood pressure were not significantly different in MAD-CPAP or MAD-sham. Quality of evidence is very low and low when MAD was compared with CPAP and sham, respectively, for AHI.