催眠对阻塞性睡眠呼吸暂停的严重程度和内型:系统性审查和元分析
Ludovico Messineo1, Scott A Sands1, Gonzalo Labarca1,2
1Division of Sleep and Circadian Disorders, Department of Medicine, and Department of Neurology, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts; and.
概括
常见的催眠药极小地增加了唤醒值,但没有改善阻塞性睡眠呼吸暂停 (OSA) 的严重程度. 除了特定的患者群体,我们不鼓励对OSA的催眠药进行进一步的研究.
科学领域:
- 睡眠医学 睡眠医学
- 药理学 药理学是指药理学的学科.
- 呼吸系统医学 呼吸系统医学
背景情况:
- 阻塞性睡眠呼吸暂停 (OSA) 通常与低兴奋值和肌肉反应不佳有关.
- 研究了催眠药的潜力,通过增加兴奋值和神经光反应能力来治疗OSA.
研究的目的:
- 评估常见催眠药对唤醒值,OSA严重程度和神经光反应能力的影响.
- 评估兴奋值变化与治疗后的呼吸暂停-呼吸暂停指数 (AHI) 之间的关联.
主要方法:
- 来自MEDLINE,Embase,CENTRAL和ClinicalTrials.gov.gov的随机临床试验的元分析.
- 对个体患者数据进行元分析,以探索兴奋值变化与AHI之间的关系.
- 使用推评估,开发和评估 (GRADE) 系统等级评估的证据质量 (QoE).
主要成果:
- 催眠药对唤醒值的增加很小 (2.7厘米的H2O压力波动;中度的QOE),但没有显著改变OSA严重程度 (-1.4事件/小时;中度的QOE).
- 在兴奋值变化和AHI降低之间没有发现总体关联.
- 在具有非常低兴奋值或与安慰剂相比兴奋值增加0-25%的个体中观察到适度的AHI降低 (∼10%); genioglossus响应性没有受到影响 (高QOE).
结论:
- 一般不建议临床使用或进一步研究催眠药作为独立的OSA治疗方法.
- 例外情况包括患有并发性失眠症的患者或具有非常低兴奋值的患者,可能受益于组合治疗.
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