Abstract
Obstructive sleep apnea (OSA) is a common breathing disorder, and continuous positive airway pressure (CPAP) therapy together with its alternatives has been developed to treat this disease. This network meta-analysis (NMA) was aimed to compare the efficacy of treatments for OSA. Cochrane Library, MEDLINE, and Embase were searched for eligible studies. A conventional and NMA was carried out to compare all therapies. Sleeping characteristics, including Apnea–Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), arterial oxygen saturation, and arousal index (AI), and changes of blood pressure were selected as outcomes. A total of 84 studies were finally included after rigorous screenings. For the primary outcomes of AHI and ESS, the value of auto-adjusting positive airway pressure (APAP), CPAP, and oral appliance (OA) all showed statistically reduction compared with inactive control (IC). Similar observation was obtained in AI, with treatments of the three active interventions. A lower effect of IC in SaO2 was exhibited when compared with APAP, CPAP, and OA. Similar statistically significant results were presented in 24 h systolic blood pressure and 24 h DBP when comparing with CPAP. Our NMA identified CPAP as the most efficacious treatment for OSA patients after the evaluation of sleeping characteristics and blood pressures. In addition, more clinical trials are needed for further investigation due to the existence of inconsistency observed in this study.
Highlights
Obstructive sleep apnea (OSA) is a common breathing disorder which is identified by repetitive air flow reduction or cessation during sleep [1]
network meta-analysis (NMA) regarding Apnea–Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), arousal index (AI), SaO2, and blood pressures was performed to evaluate the efficacy of continuous positive airway pressure (CPAP), adjusting positive airway pressure (APAP), and oral appliance (OA) in OSA patients
As a first line therapy for OSA, CPAP was first recommended by the American College of Physicians [100], and Wright and White proposed in 2000 that the effect of CPAP on sleepiness is clinically significant since CPAP therapy is able to improve the life quality of OSA patients [101]
Summary
Obstructive sleep apnea (OSA) is a common breathing disorder which is identified by repetitive air flow reduction or cessation during sleep [1]. The prevalence of OSA is estimated between 2 and 4%, varying with obesity status, gender, and age of populations [2, 3], usually caused by repetitive pharynx dysfunction which leads to apnea and hypopnea that result in the down regulation of blood oxygen levels [4]. Oxygen desaturation triggered by chronic hypoxia further causes repetitive arousals and significant changes in both transmural and intra-thoracic pressure. This mechanism can increase the sympathetic activity and oxidative stress on the heart and intra-thoracic vessels, eventually resulting in vascular damages [5]. The severity of OSA can be classified by the Apnea–Hypopnea Index (AHI), evaluating the episode frequency of apnea/hypopnea in 1 h [4], which can be used to predict the relative risk of OSA. OSA can be evaluated by using the Epworth Sleepiness Scale (ESS), which considers both daytime sleepiness and the average sleep propensity [2, 3]
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