成年人的阻塞性睡眠呼吸暂停查:美国预防服务工作组的证据报告和系统审查
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
概括
对阻塞性睡眠呼吸暂停 (OSA) 的查的准确性不确定. 像CPAP这样的治疗方法可以减轻症状和血压, 但它们对死亡率的影响仍未得到证实, 尽管生活质量有所改善.
科学领域:
- 睡眠医学
- 预防性心脏病学
- 公共卫生
背景情况:
- 阻塞性睡眠呼吸暂停 (OSA) 与许多不良健康结果有关.
- 有效的查和治疗策略对于初级保健至关重要.
研究的目的:
- 审查成年人查,诊断准确性和治疗的证据.
- 为美国预防服务工作组提供指导方针.
主要方法:
- 随机临床试验 (RCT),诊断准确性研究和队列研究的系统审查.
- 通过2016年10月的文献搜索,包括MEDLINE,Cochrane图书馆和EMBASE.
- 对类似研究进行的元分析.
主要成果:
- 没有RCT直接比较查与没有查.
- 查工具的准确性中等 (AUC为0. 80- 0. 83),但在高风险人群中进行了评估.
- 持续的正气压 (CPAP) 显著降低了呼吸暂停- 低呼吸暂停指数 (AHI),嗜睡 (ESS) 和血压,并改善了适度的生活质量.
- 部推进装置和减肥也减少了AHI和嗜睡.
- 队列研究显示AHI与全因死亡率之间存在关联.
结论:
- 需要进一步研究OSA查工具的临床实用性和准确性.
- 虽然OSA治疗有效降低AHI,睡眠和血压,但它们对死亡率和其他主要健康结果的影响尚未确定.
- 通过CPAP治疗,睡眠相关的生活质量略有改善.
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