The Therapeutic Effect Of Different Treatment For Obstructive Sleep Apnea Hypopnea Syndrome:A Systematic Review And Network Meta-analysis

ObjectiveObstructive sleep Apnea Hypopnea Syndrome(OSAHS)is a kind of sleep-related breathing disorder.Both American and Chinese clinical guidlines indicated Continuous Positive Airway Pressure(CPAP)as the initial treatment for adult with OSAHS.Even though,there are still some controversies about the efficacy of multiple therapies for OSAHS treatment.Therefore,the purpose of this study is to explore the differences in the therapeutic effect of multiple therapies acording to multiple outcome indicators in the treatment of OSAHS,and to provide scientific evidence for clinical decisionmaking.MethodsWe used the method of Network Meta-analysis with the outcomes of Apneahypopnea Index(AHI),Epworth Sleepiness Scale(ESS),Oxygen Desaturation Index(ODI)and Minimal Blood Oxygen Saturation in Sleep(Min Sp O2),analyzed the efficacy of CPAP,Auto-titrating Continues Positive Airway Pressure(APAP),Oral Appliance(OA),Exercise,Dietary weight loss(DWL)therapy in the treatment of OSAHS.Original literatures were obtained by retrieving electronic databases as well as relevent references with limited time from January 1,2000 to January 1,2018.Keywords including: "obstructive sleep apnea","physical therapy","Exercise","Dietary","lose weight","weightloss","reduce weight","continuous positive airway pressure","auto titrating positive airway pressure","oral applicance","mandibular advancement device",etc.Qualified literatures were evaluated according to inclusion,exclusion criteria and quality evaluation.When the I2> 50%,and P< 0.1 considered as heterogeneity was statistically significant.We use mean difference(MD)and the 95% Confidence Interval(CI)of MD as effect values.When 95% CI does not include zero,and P<0.05 considering statistically significant.Statistical analysis was performed by using STATA 14.0.Results74 Randomized Controlled Trial(RCT)were included in the qualitative description quantitative analysis with 6,577 subjects including 3556 in intervention group and 3,021 in control group.There was no significant difference between CPAP and APAP on AHI,ESS,Min Sp O2,ODI,and no statistically significant difference between APAP,CPAP and OA,on ESS,Min Sp O2 and ODI.On AHI,the differences between OA and CPAP as well as OA and APAP were statistically significant [OA vs.CPAP: MD=8.09,95%CI:(3.68,12.49),P<0.05;OA vs.APAP: MD=7.65,95%CI:(0.54,14.75),P<0.05].On the index of Min Sp O2,there was no statistically significant between Exercise,CPAP and APAP [APAP vs.Exercise: MD=2.55,95%CI:(-6.84,11.93),P<0.05;CPAP vs.Exercise: MD=5.20,95%CI:(-2.92,13.33),P<0.05;OA vs.Exercise: MD=-1.00,95%CI:(-10.66,8.65),P<0.05).The sorting results showed that CPAP and APAP had better efficacy,followed by OA.Conclusions 1.CPAP and APAP showed no difference in the outcomes of AHI,ESS,Min Sp O2,ODI and AI.To some extent,APAP can solve the shortcomings of traditional CPAP in treatment.Clinicians are recommended to consider using APAP instead of CPAP according to the specific conditions of patients.2.There was no difference between OA,CPAP and APAP in multiple outcomes.OA is relatively cheap,so clinicians are recommended to consider OA treatment according to the specific conditions of patients.3.Although exercise does not necessarily reduce the OSAHS patients with AHI and ESS level,but may relieve patients with hypoxic situation.Further researches in this respect are still needed.4.In the future treatment of OSAHS,it is recommended to adopt combined therapy,using of targeted and individualized treatment plans,and to strengthen drug treatment.As for OSAHS prevention,education should be actively promoted.