Intervention Review

Continuous positive airways pressure for obstructive sleep apnoea in adults

  1. Tammie L Giles1,*,
  2. Toby J Lasserson2,
  3. Brian Smith3,
  4. John White4,
  5. John J Wright5,
  6. Christopher J Cates2

Editorial Group: Cochrane Airways Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 4 APR 2006

DOI: 10.1002/14651858.CD001106.pub3

How to Cite

Giles TL, Lasserson TJ, Smith B, White J, Wright JJ, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD001106. DOI: 10.1002/14651858.CD001106.pub3.

Author Information

  1. 1

    Adelaide, South Australia, Australia

  2. 2

    St George's, University of London, Community Health Sciences, London, UK

  3. 3

    Queen Elizabeth Hospital, Department of Medicine, University of Adelaide, Woodville, South Australia 5011, Australia

  4. 4

    York District Hospital, Respiratory Medicine, York, North Yorks, UK

  5. 5

    Bradford Royal Infirmary, Bradford Institute for Health Research , Bradford, W. Yorkshire, UK

*Tammie L Giles, 2 Cork Street, Athelstone, Adelaide, South Australia, 5076, Australia. tammieg_27@yahoo.com.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Obstructive sleep apnoea is the periodic reduction (hypopnoea) or cessation (apnoea) of breathing due to narrowing or occlusion of the upper airway during sleep. The main symptom is daytime sleepiness and it has been suggested it is linked to premature death, hypertension, ischaemic heart disease, stroke and road traffic accidents.

Objectives

The main treatment for sleep apnoea is with the use of continuous positive airways pressure (CPAP), which requires a flow generator and mask. These are used at night to prevent apnoea, hypoxia and sleep disturbance. The objective was to assess the effects of CPAP in the treatment of obstructive sleep apnoea in adults.

Search methods

We searched the Cochrane Airways Group Trials Register and reference lists of articles. We consulted experts in the field. Searches were current to July 2005.

Selection criteria

We included randomised trials comparing nocturnal CPAP with an inactive control or oral appliances in adults with obstructive sleep apnoea (an apnoea and hypopnoea index greater than five per hour). Trials had a minimum intervention period of two weeks.

Data collection and analysis

Trial quality was assessed and two review authors extracted data independently. Study authors were contacted for missing information. Parallel and crossover group trials were analysed separately.

Main results

Thirty-six trials involving 1718 people met the inclusion criteria. Study quality was mixed. Compared with control, CPAP showed significant improvements in certain objective and subjective sleepiness, measures of quality of life and cognitive function (parallel-group studies: Epworth sleepiness scale (ESS) -3.83 units, 95% CI -4.57 to -3.09; crossover studies: ESS -1.84 units, 95% CI -2.57 to -1.11). Twenty-four hour systolic and diastolic blood pressures were lower with CPAP compared with control (parallel-group trials). Compared with oral appliances, CPAP significantly reduced the apnoea and hypopnoea index (crossover studies: -7.97 events/hr, 95% CI -9.56 to -6.38) and improved sleep efficiency (crossover studies: 2.31%, 95% CI 0.02 to 4.6) and minimum oxygen saturation (4.14%, 95% CI 3.25 to 5.03). Responders to both treatments expressed a strong preference for the oral appliance. However, participants were more likely to withdraw on OA than on CPAP therapy.

Authors' conclusions

CPAP is effective in reducing symptoms of sleepiness and improving quality of life measures in people with moderate and severe obstructive sleep apnoea (OSA). It is more effective than oral appliances in reducing respiratory disturbances in these people but subjective outcomes are more equivocal. Certain people tend to prefer oral appliances to CPAP where both are effective. This could be because they offer a more convenient way of controlling OSA. Short-term data indicate that CPAP leads to lower blood pressure than control. Long-term data are required for all outcomes in order to determine whether the initial benefits seen in short-term clinical trials persist.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Continuous positive airways pressure for relieving signs and symptoms of obstructive sleep apnoea

Obstructive sleep apnoea is the term used to describe the interruption in normal breathing of individuals during sleep. It is caused by collapse of the upper airways during sleep and is strongly associated with obesity. The mainstay of medical treatment is a machine used at night to apply continuous positive airways pressure (CPAP). The machine blows air through the upper air passages via a mask on the mouth or nose to keep the throat open. We searched and reviewed all randomised controlled trials that had been undertaken to evaluate the benefit of CPAP in adult patients with sleep apnoea. Some of the trials had methodological flaws, although more recent studies have begun to use appropriate forms of control. The overall results demonstrate that in people with moderate to severe sleep apnoea CPAP can improve measures of sleepiness, quality of life and associated daytime sleepiness. CPAP leads to lower blood pressure compared with control, although the degree to which this is achieved may depend upon whether people start treatment with raised blood pressures. Oral appliances are also used to treat sleep apnoea but, whilst some people find them more convenient to use than CPAP, they do not appear to be as effective at keeping the airway open at night. Further good quality trials are needed to define who benefits, by how much and at what cost. Further trials are also needed to evaluate the effectiveness of CPAP in comparison to other interventions, particularly those targeted at obesity.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

連續式正壓呼吸輔助器對成人阻塞性睡眠呼吸中止症之研究

阻塞性睡眠呼吸中止症是因為在睡眠時因上呼吸道狹窄或關閉導致呼吸週期性的減少或停止所引起的。主要的症狀是白天嗜睡,此症狀可能跟早死,高血壓,缺血性心臟病,中風和交通意外的風險有相關

目標

治療阻塞性睡眠呼吸中止症主要的方法為配戴可提供氣流與附有面罩的連續式正壓呼吸器。連續式正壓呼吸器在晚上使用可以避免呼吸中止,缺氧和睡眠障礙。本研究之研究目的為了解連續式正壓呼吸輔助對於罹患阻塞性睡眠呼吸中止症的成人的治療效果

搜尋策略

我們收尋考科藍資料庫中呼吸道群的試驗登錄和論文參考,我們也請教了專家的意見,而收尋文章為2005的七月以前

選擇標準

我們選擇了比較有阻塞性睡眠呼吸中止症的成人在夜間使用連續式正壓呼吸輔助器和非積極控制組或用口內裝置組,試驗的介入時間為兩個星期

資料收集與分析

評估試驗的品質從兩篇獨立的回顧性文章中擷取資料,而研究的文章和研究議題是有關聯的,平行和交叉試驗組被分開地作分析

主要結論

36個試驗包含1718人符合納入條件,和對照組比較,使用連續式正壓呼吸輔助器明顯的改善睡眠,生活品質和認知功能(平行試驗研究組:嗜睡指數減少3.83分,95%信賴區間從減少4.57到減少3.09,交叉試驗研究組:嗜睡指數減少1.84分,95%信賴區間從減少2.57到減少1.11),24小時的收縮壓和舒張壓在使用連續式正壓呼吸輔助器這組比對照組低(平行試驗研究),若和口內裝置比較,使用連續式正壓呼吸輔助器可明顯地減少睡眠呼吸障礙(交叉試驗研究:每小時減少7.97次,95%信賴區間從減少9.56到減少6.38)和改善睡眠效率(交叉試驗研究:改善2.31%,95%信賴區間從0.02到4.6)和改善最低血氧飽和度(改善4.14%,95%信賴區間從3.25到5.03),試驗者較偏好使用口內裝置然而中途退出試驗的比率在口內裝置組高於使用連續式正壓呼吸輔助器這組

作者結論

對於中度和重度的阻塞性睡眠呼吸中止症,使用連續式正壓呼吸輔助器能有效的改善睡眠的症狀和生活品質,它比口內裝置更有效地減少睡眠呼吸障礙,但當兩者都有效時,有些人偏愛使用口內裝置因為較方便,短期的資料顯示,使用連續式正壓呼吸輔助器比口內裝置更能降低血壓,但還需要長期的研究結果去支持此效用

翻譯人

本摘要由國泰綜合醫院林茵翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

連續式正壓呼吸輔助器可減輕睡眠呼吸中止症的徵狀及症狀,而睡眠呼吸中止症是指個體正常的呼吸於睡眠期間中斷. 是因為睡眠期間上呼吸道中斷且與肥胖有高相關。主要的治療方式為於夜間睡眠時配戴連續式正壓呼吸輔助器。此儀器是透過面罩將氣流由口或鼻傳送到上呼吸道以保持呼吸道暢通. 我們研究並回顧隨機控制的試驗但都沒有有效評估連續式正壓呼吸輔助器對罹患睡眠呼吸中止症的成人病患之益處。 有些研究有方法上的缺陷,但是目前以有更多研究使用合式的控制組還做研究。總結上述結果我們發現配戴連續式正壓呼吸輔助器的中度至重度睡眠呼吸中止症的病患可以改善睡眠,生活品質與日間嗜睡。雖然配戴連續式正壓呼吸輔助器能使血壓比控制組低, 但這可能也跟治療時是否就已有較高的血壓有關.止鼾牙套也被用來治療睡眠呼吸中止症,但是有些人覺得使用連續式正壓呼吸輔助器較為方便,因為止鼾牙套可能無法有效的保持這些病患睡眠時的呼吸道暢通。未來的研究可能可加強定義各種治療方式的效果與費用等,以及評估連續式正壓呼吸輔助器與其他介入之比較,特別是肥胖之治療目標