持续气道正压通气治疗癫与阻塞性睡眠呼吸暂停综合征共病疗效的系统评价

Systematic review of efficacy of continuous positive airway pressure in treatment of epilepsy with obstructive sleep apnea syndrome

目的评价持续气道正压通气治疗癫与阻塞性睡眠呼吸暂停综合征共病的有效性。方法以sleep apnoea、obstructive sleep apnoea、OSA、obstructive sleep apnoea syndrome、OSAS、sleep apnoea syndromes、sleep-related breathing disorder、epilepsy、continuous positive airway pressure、CPAP等英文词汇计算机检索1980年1月1日-2017年2月28日美国国立医学图书馆生物医学信息检索系统(PubMed)、荷兰医学文摘(EMBASE/SCOPUS)、Cochrane图书馆等数据库收录的关于持续气道正压通气治疗癫与阻塞性睡眠呼吸暂停综合征共病的随机对照临床试验、临床指南、系统评价(包括Meta分析)、病例对照研究、回顾性队列研究等。采用Jadad量表、Cochrane系统评价手册和RevMan 5.3统计软件进行文献质量评价和Meta分析。结果共获得1197篇英文文献,经剔除重复和不符合纳入标准者,最终纳入17篇文献,包括临床指南1篇、系统评价和Meta分析各1篇、随机对照临床试验1篇、病例对照研究10篇、回顾性队列研究3篇。结果显示:(1)持续气道正压通气可以减少癫与阻塞性睡眠呼吸暂停综合征共病患者癫发作频率甚至无发作。(2)持续气道正压通气可以减少难治性癫与阻塞性睡眠呼吸暂停综合征共病患者癫发作频率。(3)持续气道正压通气可以减少老年癫与阻塞性睡眠呼吸暂停综合征共病患者癫发作频率。(4)对3项Jadad评分≥4分的临床研究共153例癫与阻塞性睡眠呼吸暂停综合征共病患者进行Meta分析,与未接受持续气道正压通气组相比,接受持续气道正压通气组癫发作频率减少>50%的病例数增加(RR=3.170,95%CI:1.650~6.090;P=0.001)。结论持续气道正压通气可以减少癫与阻塞性睡眠呼吸暂停综合征共病患者癫发作频率,其治疗效果取决于患者依从性,突然停止或压力不足可能导致癫发作频率增加,这一结论尚待更多随机对照临床试验证实。

Objective To evaluate the efficacy of continuous positive airway pressure （CPAP） ventilation treatment for epilepsy with obstructive sleep apnea syndrome （OSAS）.Methods The data were collected from the following words：sleep apnoea,obstructive sleep apnoea,OSA,obstructive sleep apnoea syndrome,OSAS,sleep apnoea syndromes,sleep-related breathing disorder,epilepsy,continuous positive airway pressure,CPAP.PubMed,EMBASE/SCOPUS and Cochrane Library retrieval on randomized controlled clinical trials,clinical guidelines,systematic review （including Meta-analysis）,case controlled studies and retrospective cohort studies of CPAP ventilation treatment of epilepsy with OSAS from January 1,1980 to February 28,2017.Jadad Scale,Cochrane System Evaluation Handbook and RevMan 5.3 software were used for quality assessment and Meta-analysis.Results A total of 1197 English literatures were obtained,and 17 English articles were included in the study,including one clinical guideline,one systematic review,one Meta-analysis,one randomized controlled clinical trial,10 case controlled studies and 3 retrospective cohort studies.The results showed that：1） CPAP ventilation treatment can decrease the seizure frequency or even emarge seizure free in epilepsy with OSAS.2） CPAP ventilation treatment can reduce the seizure frequency of refractory epilepsy with OSAS.3） CPAP ventilation treatment can reduce the seizure frequency of elderly epilepsy patients with OSAS.4） Meta-analysis on three clinical studies （153 epilepsy and OSAS patients） with Jadad ≥ 4 scores showed cases with reduction seizure frequency 〉 50% in CPAP group were more than those in unused CPAP group （RR =3.170,95%CI：1.650-6.090;P =0.001）.Conclusions CPAP ventilation treatment can reduce the seizure frequency of patients with epilepsy and OSAS.The effect of treatment depends on patients compliance.Sudden drug-withdrawl or pressure insuffiency may increase seizure frequency.This conclusion remains to be confirmed.