論文No1270
Effects of CPAP and Mandibular Advancement Devices on Health-Related Quality of Life in OSA:
A Systematic Review and Meta-analysis
Eric Kuhn, MD; Esther I. Schwarz, MD; Daniel J. Bratton, PhD; Valentina A. Rossi, MD; Malcolm Kohler, MD
Chest. 2017;151(4):786-794. doi:10.1016/j.chest.2017.01.020
＜背景＞
未治療のOSAは健康関連QOLが障害されており、過剰な昼間の眠気は治療で改善することが示されている。
この研究の目的は、OSAの健康関連QOLが改善するか、CPAPと下顎前進装置(MAD)で比較することである。
＜方法＞
MEDLINEとCochrane Libraryを2015年11月まで検索してランダム化コントロール試験(RCTs)でCPAPとMAD、コントロールを比較した論文を調べた。
OSAの健康関連QOLは36-Item Short Form Health Survey (SF-36)でしらべた。
研究の性格、質、バイアスは３人の著者で独立して行った。
ネットワークメタ解析を単変量ランダム効果メタ回帰分析として行い、SF-36の精神コンポーネントスコア(MCS)、身体コンポーネントスコア(PCS)を評価した。
＜結果＞
1491本の論文のうち、23本がメタ解析された(2342名）。
コントロールと比較して、CPAPは1.7点MCSが改善し(95% CI, 0.1-3.2; P = .036)、1.7点PCSが改善した (95% CI, 0.5-2.9; P = .005)。
MADはMCSが2.4点改善し (95% CI, 0.0-4.9; P = .053)、PCSが1.5点(95% CI, –0.2 to 3.2; P = .076)改善した。
SF-36に関してCPAPとMADで有意な差はなかった。
＜感想＞
CPAPとMADはほぼ同等にSF-36を改善したようです。
Background Untreated OSA is associated with impaired health-related quality of life (QoL) and excessive daytime sleepiness, which have been shown to improve with treatment. The aim was to compare the effects of CPAP and a mandibular advancement device (MAD) on health-related QoL in OSA.
Methods MEDLINE and the Cochrane Library were searched up to November 2015 for randomized controlled trials (RCTs) comparing the effect of CPAP, MADs, or an inactive control treatment on health-related QoL assessed by the 36-Item Short Form Health Survey (SF-36) in OSA. Extraction of study characteristics, quality, and bias assessment were independently performed by three authors. A network meta-analysis using multivariate random-effects meta-regression was performed to assess treatment effects on the mental component score (MCS) and the physical component score (PCS) of the SF-36.
Results Of 1,491 identified studies, 23 RCTs were included in the meta-analysis (2,342 patients). Compared with an inactive control, CPAP was associated with a 1.7 point (95% CI, 0.1-3.2; P = .036) improvement in the MCS and a 1.7 point (95% CI, 0.5-2.9; P = .005) improvement in the PCS. MADs were associated with a 2.4 point (95% CI, 0.0-4.9; P = .053) and a 1.5 point (95% CI, –0.2 to 3.2; P = .076) improvement in the MCS and PCS, respectively, compared with inactive control treatments. There were no statistically significant differences between treatment effects of CPAP and MAD on the SF-36 scores.
Conclusions CPAP is effective in improving health-related QoL in OSA, and MADs may be just as effective, but further RCTs comparing the two treatments are required.