可调式与固定式口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征通气效果影响的系统评价

The systematic review of the effect between adjustable and fixed oral appliance on ventilation of obstructive sleep apnea hypopnea syndrome

目的 评价可调式口腔矫治器（oral appliance,OA）对阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）患者通气情况的影响.方法 电子检索数据库自1990年1月至2014年7月国内外口腔矫治器对OSAHS患者通气情况影响的随机对照试验.采用RevMan5.2软件进行数据合并分析.无法转换合并的数据采用描述性分析.结果 共纳入6个随机对照试验,共1 109例患者,包括4个随机平行对照试验和2个随机交叉对照试验.Meta分析结果显示,可调式口腔矫治器有利于改善患者的睡眠呼吸暂停低通气指数（apnea-hypopnea index,AHI）,固定效应模型,加权均数差（WMD）=-2.38,95％可信区间（CI）-359～-1.17,P＜0.01,提高最低血氧饱和度SaO2,随机效应模型,WMD=3.09,95％CI1.16～5.02,P＜0.01.由于睡眠评分数据类型不同无法合并,故采用描述性分析,结果显示数据差异无统计学意义.结论 可调式口腔矫治器更有利于降低AHI,提高最低（SaO2）,但睡眠评分无明显的改善,需设计更多大样本、多中心随机对照试验,以对可调式口腔矫治器的综合效果进行验证.

Objective To evaluate the efficacy of adjustable oral appliance （OA） on ventilation of patients with obstructive sleep apnea hypopnea syndrome （OSAHS）.Methods Databases were searched from Junuary 1990 to July 2014 for randomized controlled trials on the use of adjustable OA for the promotion of ventilation in OSAHS.Meta analysis was performed with RevMan5.2 software,and descriptive analysis of the data that could not be converted and merged was performed.Results Totally 6 RCTs involved,including 1 109 patients,which involved 4 random parallel controlled trials and 2 random crossover controlled trials.Meta-analysis showed that adjustable OA were associated with a decreased apnea-hypopnea index（AHI） [fixed effect model,WMD=-2.38,95%CI （-3.59--1.17）,P〈0.01] and an improvement in minimum arterial oxygen saturation （SaO2）[randomized effect model,WMD=3.09,95%CI（1.16-5.02）,P〈0.01] of OSAHS patients.The descriptive analysis showed that the difference in the sleep score was not statistically significant because the data could not be converted.Conclusions Compared to fixed oral appliance,adjustable oral appliance produced greater effect in reduction of AHI and the improvement in minimum SaO2,but the sleep score is not improved significantly,the large sample and multi-center randomized controlled test needs to be designed for the verification of comprehensive effect of adjustable oral appliance.