目的:分析下颌前移装置(MAD)在睡眠呼吸暂停治疗中的相对疗效。
方法:来自符合条件的随机对照试验(RCT),MAD根据其机械设计进行分类。呼吸暂停低通气指数(AHI)的数据,Epworth嗜睡量表(ESS),最低点氧饱和度(minSaO2),然后在网络荟萃分析中分析RCT的睡眠效率(SE%),不同MAD的相对排名是根据P分数计算的(一种类似于SUCRA的排名方法)。基于不同品牌的MAD进行了类似的分析。
结果:在分析的任何结果中,MAD之间没有统计学上的显著差异。然而,P分数,基于网络估计的点估计和标准误差,在一些结果中,一些MAD的排名高于其他MAD。在不同的机械设计中,附加中线牵引(P分数=0.84)和非附加双侧交锁(P分数=0.78)装置用于减少AHI,P分数最高。ESS的附着双侧牵引(P分数=0.78)和未附着双侧互锁(P分数=0.76),minSaO2的单体(P分数=0.91)和未连接的双侧互锁(P分数=0.64),SE%的未连接的双侧互锁(P分数=0.82)和连接的双侧牵引(P分数=0.77)。基于MAD品牌的网络荟萃分析中的显著发现,在指定它们的有限数量的研究中,SomnoDentFlex™的影响,TAP™,和IST®对AHI降低的影响,P分数分别为0.94、0.83和0.82。整体降低仰卧AHI最大(-44.46[-62.55;-26.36],P分数=0.99),并且未连接的双侧互锁对REM-AHI的影响最大(-11.10[-17.10;-5.10],P分数=0.87)。
结论:这项研究的结果显示,当分析不同的睡眠呼吸暂停治疗结果和睡眠呼吸暂停表型时,MAD在临床上(但不具有统计学意义)在相对疗效方面存在显著差异。
To analyze relative efficacies of mandibular advancement devices (MAD) in sleep apnea treatment.
From eligible randomized controlled trials (RCT), MADs were classified based on their mechanistic designs. Data on apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), nadir oxygen saturation (minSaO2), and sleep efficiency (SE%) from RCTs were then analyzed in network meta-analyses, and relative ranking of different MADs was computed based on P scores (a method of ranking similar to SUCRA). Similar analyses were conducted based on the different brands of MADs.
There were no statistically significant differences between MADs in any of the outcomes analyzed. However, the P-scores, based on the point estimates and standard errors of the network estimates, ranked some MADs higher than others in some of the outcomes. Of the different mechanistic designs, the highest P scores were achieved for attached midline traction (P score = 0.84) and unattached bilateral interlocking (P score = 0.78) devices for AHI reduction, attached bilateral traction (P score = 0.78) and unattached bilateral interlocking (P score = 0.76) for ESS, monobloc (P score = 0.91) and unattached bilateral interlocking (P score = 0.64) for minSaO2, and unattached bilateral interlocking (P score = 0.82) and attached bilateral traction (P score = 0.77) for SE%. Notable findings in the network meta-analyses based on MAD brands, of the limited number of studies that specified them were the effects of SomnoDent Flex™, TAP™, and IST® in their effects on AHI reduction, with P scores of 0.94, 0.83, and 0.82, respectively. Monobloc decreased supine-AHI the most (- 44.46 [- 62.55; - 26.36], P score = 0.99), and unattached bilateral interlocking had the greatest effect on REM-AHI (- 11.10 [- 17.10; - 5.10], P score = 0.87).
Findings from this study show clinically (but not statistically) significant differences between MADs in terms of their relative efficacy when analyzed for different sleep apnea treatment outcomes and sleep apnea phenotypes.