成人における阻害性睡眠時無呼吸のスクリーニング:米国予防サービスタスクフォースのための証拠報告と体系的レビュー
Daniel E Jonas1, Halle R Amick2, Cynthia Feltner1
1Department of Medicine, University of North Carolina at Chapel Hill2RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
JAMA
|January 25, 2017
まとめ
阻害性睡眠無呼吸 (OSA) のスクリーニングは不確実である. CPAPのような治療は 症状と血圧を軽減しますが 控えめな生活の質の改善にもかかわらず 死亡率への影響は まだ証明されていません
科学分野:
- 睡眠医学
- 予防的な心臓科
- 公衆衛生
背景:
- 阻害性睡眠無呼吸症候群 (OSA) は多くの健康上の悪影響と関連しています.
- 効果的なスクリーニングと治療戦略は,プライマリケアにおいて極めて重要です.
研究 の 目的:
- 成人のOSAのスクリーニング,診断の正確性,治療に関する証拠をレビューする.
- 予防サービス・タスク・フォースの指針を提示する.
主な方法:
- ランダム化臨床試験 (RCT),診断精度試験,およびコホート試験の体系的なレビュー.
- 2016年10月までの文献検索は,MEDLINE,コクラン図書館,EMBASEを含む.
- 比較研究で実施されたメタ解析
主要な成果:
- スクリーニングと無スクリーニングを直接比較したRCTはありません.
- スクリーニングツールは適度な精度 (AUC 0. 80- 0. 83) を示したが,高リスク集団で評価された.
- 継続的な陽性呼吸道圧 (CPAP) は,アプネア・ヒポネア指数 (AHI),眠気 (ESS),および血圧を著しく低下させ,生活の質にわずかな改善をもたらした.
- マンジブラー・アドバンス装置と体重減少は AHIと眠気を減少させました
- コホート研究では,AHIと全因死亡率との関連が示されました.
結論:
- OSAスクリーニングツールの臨床的有用性と正確性は,さらなる調査を必要とする.
- OSA治療はAHI,眠気,血圧を効果的に軽減しますが,死亡率やその他の主要な健康上の結果への影響はまだ確立されていません.
- CPAP治療は睡眠関連の生活の質に わずかな改善をもたらします
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