成人における阻害性睡眠時無呼吸のスクリーニング:米国の予防サービスタスクフォースのための最新証拠報告と体系的レビュー
Cynthia Feltner1,2,3, Ina F Wallace1,4, Shannon Aymes2
1RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
JAMA
|November 15, 2022
まとめ
成人における阻害性睡眠無呼吸 (OSA) のスクリーニングの正確性と臨床的有用性は不明である. 呼吸道圧力の改善のような治療は 眠気や生活の質を改善しますが 死亡率や重篤な健康上の出来事を 大幅に減らすことはできません
科学分野:
- 睡眠医学
- 予防的な健康
- 臨床診断
背景:
- 阻害性睡眠無呼吸症候群 (OSA) は,深刻な健康上の悪影響と関連しています.
- 早期発見と介入には 効果的なスクリーニング戦略が必要です
研究 の 目的:
- 無症状または未診断の成人のOSAのスクリーニングテストの精度に関する証拠を評価する.
- 予防サービス・タスク・フォースの勧告を参考にする.
主な方法:
- スクリーニングテストの精度研究,ランダム化臨床試験 (RCT),メタ解析の体系的なレビュー.
- 大規模なデータベース (PubMed,Embase,Cochrane) と試験登録簿で検索しました
- 検査の精度,生活の質,健康上の結果について報告した研究が含まれています.
主要な成果:
- 多変性無呼吸予測スコアは,重度のOSAに対して良好な精度 (AUC 0. 80- 0. 83) を示した.
- 陽性呼吸道圧 (PAP) と下進出装置は,過度の昼間の眠気 (ESS) と生活の質 (QOL) を改善しました.
- PAP治療で死亡率,心血管疾患,事故の有意な減少は認められなかったが,血圧の低下は控えめであった.
結論:
- 主治医療におけるOSAスクリーニングツールの臨床的有用性と正確性は不明である.
- PAPと下の進出装置は症状とQOLを改善しますが,主要な健康結果への長期的な影響についてはさらなる調査が必要です.
- 死亡率や重大な有害事象を減らすためのスクリーニングは 根拠がない.
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