目的:阻塞性睡眠呼吸暂停(OSA)患者的自主神经功能受损,并可能介导OSA与心血管风险之间的关联。我们通过对干预研究的系统评价和荟萃分析,调查了OSA治疗对自主神经功能的影响。
方法:使用三个数据库的系统搜索(Medline,Embase,和Scopus)执行时间截至2020年12月9日。在气道正压通气治疗前后评估≥18岁的OSA患者自主神经功能的研究,口腔矫治器,位置疗法,减肥,或手术干预被纳入审查。对5组自主神经功能指标进行随机效应Meta分析。使用Cochrane协作工具评估偏倚风险。
结果:对43项符合条件的研究进行了综述,其中39项纳入了荟萃分析。OSA治疗导致肌肉交感神经活动大幅下降(Hedges\'g=-1.08;95%CI-1.50,-0.65,n=8),儿茶酚胺(-0.60;-0.94,-0.27,n=3)和放射性核苷酸成像(-0.61;-0.99,-0.24,n=2)中度下降。OSA治疗对压力反射功能(Hedges\'g=0.15;95%CI-0.09,0.39,n=6)或心率变异性(0.02;-0.32,0.36,n=14)无显著影响。由于研究主要是非随机试验,因此存在明显的偏倚风险。
结论:OSA治疗选择性地改善自主神经功能。最有力的证据表明,OSA治疗对自主神经功能的影响是通过微神经造影评估的交感神经活动减少,但副交感神经功能没有改善。OSA治疗可以通过减少交感神经活性来降低OSA中心血管疾病的风险。
OBJECTIVE: Autonomic function is impaired in obstructive sleep apnea (OSA) and may mediate the association between OSA and cardiovascular risk. We investigated the effect of OSA therapy on autonomic function through a systematic
review and meta-analysis of intervention studies.
METHODS: A systematic search using three databases (Medline, Embase, and Scopus) was performed up to December 9, 2020. Studies of OSA patients ≥ 18 years with autonomic function assessed before and after treatment with positive airway pressure, oral appliance, positional therapy, weight loss, or surgical intervention were included for
review. Random effects meta-analysis was carried out for five groups of autonomic function indices. Risk of bias was assessed using the Cochrane Collaboration tool.
RESULTS: Forty-three eligible studies were reviewed with 39 included in the meta-analysis. OSA treatment led to large decreases in muscle sympathetic nerve activity (Hedges\' g = -1.08; 95% CI -1.50, -0.65, n = 8) and moderate decreases in catecholamines (-0.60; -0.94, -0.27, n = 3) and radio nucleotide imaging (-0.61; -0.99, -0.24, n = 2). OSA therapy had no significant effect on baroreflex function (Hedges\' g = 0.15; 95% CI -0.09, 0.39, n = 6) or heart rate variability (0.02; -0.32, 0.36, n = 14). There was a significant risk of bias due to studies being primarily non-randomized trials.
CONCLUSIONS: OSA therapy selectively improves autonomic function measures. The strongest evidence for the effect of OSA therapy on autonomic function was seen in reduced sympathetic activity as assessed by microneurography, but without increased improvement in parasympathetic function. OSA therapy may reduce the risk of cardiovascular disease in OSA through reduced sympathetic activity.