• 1 上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院呼吸內(nèi)科（上海 200092）;;
  • 2 上海交通大學(xué)新華臨床醫(yī)學(xué)院流行病學(xué)與統(tǒng)計(jì)學(xué)教研室;

目的  評(píng)價(jià)持續(xù)氣道正壓通氣（CPAP）治療阻塞性睡眠呼吸暫停綜合征（OSAS）患者的主觀嗜睡程度和心理變化。方法   計(jì)算機(jī)檢索截止至2007年發(fā)表的文獻(xiàn)（MEDLINE、EMBASE、CBMdisk等），分析符合條件的9項(xiàng)隨機(jī)對(duì)照試驗(yàn)（RCT）中的Epworth嗜睡量表及有關(guān)心理評(píng)估量表的結(jié)果。由2名評(píng)價(jià)者獨(dú)立對(duì)納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià)，并提取資料，如有分歧，通過(guò)討論解決。采用RevMan4.2進(jìn)行Meta分析。結(jié)果  9項(xiàng)RCT共納入665例患者。Meta分析顯示，CPAP治療后的Epworth嗜睡量表評(píng)分分值降低[－2.94，95%CI（－4.68，－1.20），隨機(jī)效應(yīng)模型]，一般健康狀況量表-28的分值降低[－2.26，95%CI（－3.79，－0.72），固定效應(yīng)模型]，而合并分析醫(yī)院焦慮抑郁量表的分值變化無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論   依據(jù)現(xiàn)有的臨床證據(jù)，應(yīng)用CPAP后OSAS患者的日間主觀嗜睡程度和整體的精神健康狀況得以改善，但對(duì)緩解患者焦慮和抑郁情緒則無(wú)明顯效果。

引用本文： 董歡霽 ,郭雪君,徐衛(wèi)國(guó),羅勇,許小幸. 持續(xù)氣道正壓通氣治療阻塞性睡眠呼吸暫停綜合征患者的主觀嗜睡程度和心理變化的Meta分析. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 08(5): 376-382. doi: 復(fù)制

1. Ferini-Strambi L，F(xiàn)antini ML，Castronovo C.Epidemiology of obstructive sleep apnea syndrome.Minerva Med，2004，95：187-202.
2. Sakurai S.Physiopathology and complications of sleep apnea syndrome.Cheyne-Stokes respiration syndrome.Nippon Naika Gakkai Zasshi，2004，93：1109-1113.
3. Peng B，Li SW，Kang H，et al.Cognitive and emotional impairment in obstructive sleep apnea syndrome.Chin Med Sci J，2004，19：262-265.
4. Johns MW.Daytime sleepiness，snoring，and obstructive sleep apnea.The Epworth Sleepiness Scale.Chest，1993，103：30-36.
5. Gugger M，Bassetti C.Effectiveness of nasal CPAP-treatment（continuous positive airway pressure）.Ther Umsch，2000，57：444-448.
6. Berwick DM，Budman S，Damico-White J，et al.Assessment of psychological morbidity in primary care：explorations with the General Health Questionnaire.J Chron Dis，1987，40（Suppl 1）：71S-84S.
7. Zigmond AS，Snaith RP.The hospital anxiety and depression scale.Acta Psychiatr Scand，1983，67：361-370.
8. Jadad AR，Moore RA，Carroll D，et al.Assessing the quality of reports of randomized clinical trials：is blinding necessary? Control Clin Trials，1996，17：1-12.
9. Engleman HM，Martin SE，Deary IJ，et al.Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome.Lancet，1994，343：572-575.
10. Engleman HM，Martin SE，Deary IJ，et al.Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome.Thorax，1997，52：114-119.
11. Engleman HM，Martin SE，Kingshott RN，et al.Randomised placebo controlled trial of daytime function after continuous positive airway pressure（CPAP） therapy for the sleep apnoea/hypopnoea syndrome.Thorax，1998，53：341-345.
12. Engleman HM，Kingshott RN，Wraith PK，et al.Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome.Am J Respir Crit Care Med，1999，159：461-467.
13. Montserrat JM，F(xiàn)errer M，Hernandez L，et al.Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome：a randomized controlled study with an optimized placebo.Am J Respir Crit Care Med，2001，164：608-613.
14. Faccenda JF，Boon NA，Mackay TW，et al.CPAP effects on blood pressure in the sleep apnea/hypopnea syndrome（SAHS） during a randomized controlled trial.Am J Respir Crit Care Med，2000，161（Suppl 3）：344-348.
15. Barnes M，Houston D，Worsnop CJ，et al.A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea.Am J Respir Crit Care Med，2002，165：773-780.
16. Barnes M，McEvoy RD，Banks S，et al.Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea.Am J Respir Crit Care Med，2004，170：656-664.
17. Marshall NS，Neill AM，Campbell AJ，et al.Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea.Thorax，2005，60：427-432.
18. 李延忠，主編.睡眠呼吸障礙性疾病.山東：山東科學(xué)技術(shù)出版社，2005，148-149.
19. 但漢雷，白楊，張亞歷，等.Meta分析方法及其醫(yī)學(xué)科研價(jià)值與評(píng)價(jià).中華醫(yī)學(xué)科研管理雜志，2003，16：12-15.
20. SIGN（Scottish Intercollegiate Guideline Network）.Management of obstructive sleep apnoea/hypopnoea syndrome in adults（guideline no.73）.www.sign.ac.uk.
21. 王吉耀，主編.循證醫(yī)學(xué)與臨床實(shí)踐.北京：科學(xué)出版社，2002，55-58.
  1. 1. Ferini-Strambi L，F(xiàn)antini ML，Castronovo C.Epidemiology of obstructive sleep apnea syndrome.Minerva Med，2004，95：187-202.
  2. 2. Sakurai S.Physiopathology and complications of sleep apnea syndrome.Cheyne-Stokes respiration syndrome.Nippon Naika Gakkai Zasshi，2004，93：1109-1113.
  3. 3. Peng B，Li SW，Kang H，et al.Cognitive and emotional impairment in obstructive sleep apnea syndrome.Chin Med Sci J，2004，19：262-265.
  4. 4. Johns MW.Daytime sleepiness，snoring，and obstructive sleep apnea.The Epworth Sleepiness Scale.Chest，1993，103：30-36.
  5. 5. Gugger M，Bassetti C.Effectiveness of nasal CPAP-treatment（continuous positive airway pressure）.Ther Umsch，2000，57：444-448.
  6. 6. Berwick DM，Budman S，Damico-White J，et al.Assessment of psychological morbidity in primary care：explorations with the General Health Questionnaire.J Chron Dis，1987，40（Suppl 1）：71S-84S.
  7. 7. Zigmond AS，Snaith RP.The hospital anxiety and depression scale.Acta Psychiatr Scand，1983，67：361-370.
  8. 8. Jadad AR，Moore RA，Carroll D，et al.Assessing the quality of reports of randomized clinical trials：is blinding necessary? Control Clin Trials，1996，17：1-12.
  9. 9. Engleman HM，Martin SE，Deary IJ，et al.Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome.Lancet，1994，343：572-575.
  10. 10. Engleman HM，Martin SE，Deary IJ，et al.Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome.Thorax，1997，52：114-119.
  11. 11. Engleman HM，Martin SE，Kingshott RN，et al.Randomised placebo controlled trial of daytime function after continuous positive airway pressure（CPAP） therapy for the sleep apnoea/hypopnoea syndrome.Thorax，1998，53：341-345.
  12. 12. Engleman HM，Kingshott RN，Wraith PK，et al.Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome.Am J Respir Crit Care Med，1999，159：461-467.
  13. 13. Montserrat JM，F(xiàn)errer M，Hernandez L，et al.Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome：a randomized controlled study with an optimized placebo.Am J Respir Crit Care Med，2001，164：608-613.
  14. 14. Faccenda JF，Boon NA，Mackay TW，et al.CPAP effects on blood pressure in the sleep apnea/hypopnea syndrome（SAHS） during a randomized controlled trial.Am J Respir Crit Care Med，2000，161（Suppl 3）：344-348.
  15. 15. Barnes M，Houston D，Worsnop CJ，et al.A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea.Am J Respir Crit Care Med，2002，165：773-780.
  16. 16. Barnes M，McEvoy RD，Banks S，et al.Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea.Am J Respir Crit Care Med，2004，170：656-664.
  17. 17. Marshall NS，Neill AM，Campbell AJ，et al.Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea.Thorax，2005，60：427-432.
  18. 18. 李延忠，主編.睡眠呼吸障礙性疾病.山東：山東科學(xué)技術(shù)出版社，2005，148-149.
  19. 19. 但漢雷，白楊，張亞歷，等.Meta分析方法及其醫(yī)學(xué)科研價(jià)值與評(píng)價(jià).中華醫(yī)學(xué)科研管理雜志，2003，16：12-15.
  20. 20. SIGN（Scottish Intercollegiate Guideline Network）.Management of obstructive sleep apnoea/hypopnoea syndrome in adults（guideline no.73）.www.sign.ac.uk.
  21. 21. 王吉耀，主編.循證醫(yī)學(xué)與臨床實(shí)踐.北京：科學(xué)出版社，2002，55-58.

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