Efficacy And Safety Of Treatments In Patients With Obstructive Sleep Apnea:A Meta-analysis

Obstructive sleep apnea hypopnea syndrome(OSAHS)is a common disease,Continueous Pasitive Airway Pressure(CPAP)and operations are commonly used in the treatment of OSAHS.Multi-level surgery was gradually popularized,but effects and complications remains uncertain.In addition,patients find it difficult to adhere to CPAP therapy for varied reasons.We collected clinical data about treatment for OSAHS,and use the method of meta-analysis and network meta-analysis;Hope to provide reference for the clinical treatment for patients with OSAHS.Part IObjective: The primary objective was to determine if sleep-related outcomes improve following multilevel surgery for obstructive sleep apnea.Study design: Systematic review and meta-analysis.Methods: The published articles were searched from Pub Med,Medline,EMbase,CNKI,WANFANG and VIP databases before October 2015 to collect randomized controlled trials or cohort studies that assessed the effectiveness of Multi-level surgery on OSAHS.The processes of study search,selection,data extraction,assessment of risk of bias and evaluation of evidence quality were conducted independently by two reviewer authors.Meta-analyses were performed in Rev Man5.3,Stata14.Results: A total of 13 studies were included for this meta-analysis.The results of meta-analysis showed that:Compared with single level surgery,multilevel surgery significantly reduced the degree of AHI,ESS,LSPO2?SMD=-0.65,95%CI(-0.81,-0.49),P<0.00001?;?SMD=-0.74,95%CI(-0.95,-0.53),P<0.00001 ?;? SMD=0.82,95 % CI(0.61,1.03),P<0.0001 ?,but not significantly reduced the degree of the complication ?RR=1.23,95%CI(0.43,3.29),p=0.68?Conclusion: This meta-analysis indicates that multilevel surgery takes remarkable effects in improving AHI,ESS,LSPO2 for OSAHS compared with single level surgery,but not significant difference in the occurrence of complications.Part IIObjective: Compare the efficacy of many treatment measures for ptients with OSAHS and the effect of CPAP in OSAHS with hypertention patients.Study Design: meta-analysis and network meta-analysis.Methods: The published articles were searched from Pub Med,Medline,EMbase,CNKI,WANFANG and VIP databases before January 2016 to collect randomized controlled trials that assessed the effectiveness of multi-level surgery on OSAHS.The processes of study search,selection,data extraction,assessment of risk of bias and evaluation of evidence quality were conducted independently by two reviewer authors.Meta-analyses were performed in Rev Man5.3?Stata14?gemtc0.14.3?openbugs 3.2.4.Results: A total of 31 studies were included for this meta-analysis.The results of meta-analysis showed that:Compared with placebo,CPAP significantly reduced the degree of SBP,DBP?SMD=-0.21,95%CI(-0.37,-0.05),P=0.01?;?SMD=-0.43,95%CI(-0.59,-0.27),P<0.00001?but not significantly reduced the degree of the cardiovascular event and mortality?OR=0.87,95%CI(0.53,1.42),P=0.58? ?OR =1.39,95%CI(0.27,7.04),P=0.69 ?,Ranking shows that: In the short term,multi-level surgery is better than CPAP of the improvement in AHI,CPAP got the best score of the method to improve ESS.Conclusion: 1.Multi-level surgery is better than other interventions to improve the AHI,CPAP is better than other interventions to improve the daytime-sleep,but two treatments have no statistically significant difference;2.To OSAHS with hypertension patients,CPAP can significantly reduce 24-hour average systolic blood pressure and 24-hour average diastolic blood pressure compared with the placebo group.3.To OSAHS patients,CPAP was not significantly difference on the incidence of long-term cardiovascular events and death compared with the placebo group,.Rigorous randomized controlled trials need to be performed to obtain clear results.