口腔矫正器和持续正压气道通气治疗轻中度OSAHS疗效比较的Meta分析

目的系统评价口腔矫正器和持续正压气道通气比较治疗轻中度睡眠呼吸暂停低通气综合征（OSAHS）的疗效。方法计算机检索PubMed、EMbase、qheCochraneLibrary、CBM、VIP、WanFangData及CNKI，查找公开发表及未发表的有关口腔矫正器（OA）和持续正压气道通气（CPAP）比较治疗OSAHS疗效的随机对照试验（RCT），检索时限均为建库至2012年11月30日，并查找相关会议论文文献，文种和发表时间不限。由2位评价者根据纳入与排除标准独立筛选文献，提取资料并评价质量后，采用RevMan5．1软件进行Meta分析，并采用GRADEpro3．6软件评价证据质量。结果最终纳入7个RCT。Meta分析结果湿示：①CPAP在改善轻中度OSAHS患者睡眠呼吸暂停低通气指数的作用更显著，其差异具有统计学意义[WMD=9．13，95％CI（8．77，9．50），P〈0．00001]；②OA和CPAP在改善轻中度OSAHS患者主观白天嗜睡方面，差异无统计学意义[WMD=0．00，95％CI（-0．12，O．12），P=0．97]。结论与OA相比，CPAP在改善轻中度OSAHS患者睡眠呼吸暂停低通气指数的作用更显著，但在改善患者主观白天嗜睡方面无显著差异。受纳入研究质量与数量所限，上述结论尚需开展更多高质量RCT加以验证。

Effectiveness of Oral Appliance versus Continuous Positive Airway Pressure in Treating Patients with Mild to Moderate Obstructive Sleep Apnea-Hypopnea Syndrome: A Meta-Analysis

Objective To evaluate the effectiveness of oral appliance （OA） vs. continuous positive airway pressure （CPAP） in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials （RCTs） on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using RevMan 5.1 software. Besides, the level of evidence was graded using GRADEpro 3.6 software. Results A total of 7 RCTs were included. The results of meta-analysis showed that： a） compared with OA, CPAP significantly reduced the degree of apnea-hypopnea index （AHI） （WMD=9.13, 95%CI 8.77 to 9.50, P〈0.000 01）; and b） there was no significant difference in the Epworth sleeping scale （ESS） between OA and CPAP （WMD=0.00, 95%CI -0.12 to 0.12, P=0.97）. Conclusion Compared with OA, CPAP takes remarkable effects in improving AHI for mild to moderate OSAHS, but it shows no significant difference in improving ESS. For the quality and quantity limitation of the included studies, this conclusion still needs to be proved by conducting more high quality RCTs.