持续的正气道压力对阻塞性睡眠呼吸暂停的成年人功能的影响:系统性审查和元分析
Hui-Hui Peng1,2, Chia-Enn Hu1,3, Yueh-Lin Wu4,5,6
1School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Sleep & breathing = Schlaf & Atmung
|February 13, 2025
概括
持续的正气压 (CPAP) 治疗对阻塞性睡眠呼吸暂停 (OSA) 的成年人减缓功能下降的影响很小. 需要进一步的研究,以在更大的试验中证实这些发现.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 肺部病理学 肺部病理学
- 睡眠医学 睡眠医学
背景情况:
- 阻塞性睡眠呼吸暂停 (OSA) 与患慢性病 (CKD) 的风险更高有关.
- 在CKD患者中OSA的高患病率表明OSA和CKD之间存在双向关系.
- 持续正气道压力 (CPAP) 可能对脏有好处,但证据仍然不确定.
研究的目的:
- 评估CPAP治疗对被诊断患有OSA的成年人功能的影响.
- 综合当前关于CPAP对OSA患者脏健康标志物的影响的证据.
主要方法:
- 在主要数据库 (PubMed,EMBASE,Cochrane,Web of Science) 和临床试验网站 (ClinicalTrials.gov) 进行系统的文献搜索,截至2024年1月.
- 包括四项随机对照试验 (RCT) 和七项非RCT (NRCT),涉及2,660名参与者.
- 使用随机效应模型进行元分析,以估计对eGFR和UACR的聚合效应.
主要成果:
- 在NRCT中,CPAP疗法显示出对eGFR下降的统计显著但最小的减少 (MD = 1.95,p < 0.001),但在RCT中没有 (MD = 1.42,p = 0.25).
- 在CPAP使用和尿白蛋白与肌素比率 (UACR) 变化之间没有观察到显著的关联.
- 对CPAP对功能下降的影响的总体证据确定性低至中等.
结论:
- 在OSA患者中,CPAP疗法似乎对减缓功能下降的进展具有有限或微不足道的影响.
- 需要进一步进行高质量的RCT,采用更大的样本大小和更长的随访时间,以确定CPAP在OSA中的脏益处.
- 目前的证据基础表明,在这种人群中,建议CPAP仅用于脏保护是需要谨慎的.
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