Impacts of conservative treatment on the clinical manifestations of obstructive sleep apnea-systematic review and meta-analysis.
CPAP
Conservative treatment
OSA
Sleep hygiene
Journal
Sleep & breathing = Schlaf & Atmung
ISSN: 1522-1709
Titre abrégé: Sleep Breath
Pays: Germany
ID NLM: 9804161
Informations de publication
Date de publication:
20 Apr 2024
20 Apr 2024
Historique:
received:
13
12
2023
accepted:
08
04
2024
revised:
08
03
2024
medline:
20
4
2024
pubmed:
20
4
2024
entrez:
20
4
2024
Statut:
aheadofprint
Résumé
Obstructive sleep apnea (OSA) is a chronic disease with a high populational prevalence that is characterized as airway closure during sleep. Treatment is multidisciplinary and varies according to each case. Continuous positive airway pressure (CPAP), oral appliances, and surgery are the primary therapeutic options. Non-invasive conservative treatments such as sleep hygiene, positional therapy, physical exercises, and weight loss aim to reduce the worsening of the disease while being complementary to the invasive primary treatment. To analyze the impact of non-invasive conservative therapies on the clinical manifestations of OSA syndrome (OSA), compared with other interventions. This was a systematic review with meta-analysis. The searches were performed without filters for the time period, type of publication, or language. Randomized clinical trials on subjects over 18 years of age diagnosed with untreated OSA were included. Responses to non-invasive conservative treatment were compared with responses to the primary intervention. Primary outcomes were assessed using the Epworth Sleepiness Scale and/or Functional Outcomes of Sleep Questionnaire (FOSQ). A total of eight studies were included in the review. The heterogeneity of the effect was estimated at 89.77%. Six studies compared conservative treatment with CPAP, one with oral appliances, and one with oropharyngeal exercises. Using the Epworth Sleepiness Scale measurements, the standardized difference in the estimated means, based on the random-effects model, was 0.457 (95% CI (1.082 to 0.169)) and the mean result did not differ significantly from zero (z = 1.43; p = 0.153). The conservative therapies assessed in this study improved the subjective quality of sleep, although the post-treatment ESE scores did not show significant results. The reduction in AHI and better outcomes in the evaluated domains, as well as in cognition and mood, were superior in the groups that received CPAP and IOD. The most commonly used treatments of choice for OSA are invasive, including the use of CPAP, oral appliances, and surgeries, being the most utilized options. This study demonstrated that non-invasive conservative treatments, such as sleep hygiene, yield results as effective as invasive treatments. Further studies are needed to confirm this result and to predict whether invasive treatment can be used as the primary treatment or only as a supplement.
Identifiants
pubmed: 38642201
doi: 10.1007/s11325-024-03034-z
pii: 10.1007/s11325-024-03034-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
Références
Semelka M, Jonathan W, Floyd R (2016) Diagnosis and treatment of obstructive sleep apnea in adults. Am Fam Physician Pennsylvania Am Fam Physician 94(5):355–360
Ye L et al (2015) Spousal involvement and CPAP adherence: a dyadic perspective. Sleep Med Rev 19:67–74. https://doi.org/10.1016/j.smrv.2014.04.005
doi: 10.1016/j.smrv.2014.04.005
pubmed: 24906222
Tan KB, Toh ST, Guilleminault C, Holty JE (2015) A cost-effectiveness analysis of surgery for middle-aged men with severe obstructive sleep apnea intolerant of CPAP. J Clin Sleep Med 11(5):525–535
doi: 10.5664/jcsm.4696
pubmed: 25700871
pmcid: 4410926
Chai-Coetzer CL, Luo YM, Antic NA, Zhang XL, Chen BY, He QY, Heeley E, Huang SG, Anderson C, Zhong NS, McEvoy RD (2013) Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study. Sleep 36(12):1929–1937
doi: 10.5665/sleep.3232
pubmed: 24293768
pmcid: 3825443
Avlonitou E, Kapsimalis F, Varouchakis G, Vardavas CI, Behrakis P (2012) Adherence to CPAP therapy improves quality of life and reduces symptoms among obstructive sleep apnea syndrome patients. Sleep Breath 16(2):563–569. https://doi.org/10.1007/s11325-011-0543-8
doi: 10.1007/s11325-011-0543-8
pubmed: 21667216
Hoffstein V (2007) Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 11(1):1–22
doi: 10.1007/s11325-006-0084-8
pubmed: 17136406
Millman RP, Rosenberg CL, Carlisle CC, Kramer NR, Kahn DM, Bonitati AE (1998) The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty. Chest 113(4):992–996
doi: 10.1378/chest.113.4.992
pubmed: 9554637
Freedman N (2010) Treatment of obstructive sleep apnea syndrome. Clin Chest Med 31:187–201. https://doi.org/10.1016/j.ccm.2010.02.012
doi: 10.1016/j.ccm.2010.02.012
pubmed: 20488281
Holty J-E, Guilleminault C (2010) Surgical options for the treatment of obstructive sleep apnea. Med Clin N Am 94:479–515. https://doi.org/10.1016/j.mcna.2010.02.001
doi: 10.1016/j.mcna.2010.02.001
pubmed: 20451028
Prinsell JR (1999) Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients. Chest 116(6):1519–1529
doi: 10.1378/chest.116.6.1519
pubmed: 10593771
Baranwal N, Phoebe KY, Siegel NS (2023) Sleep physiology, pathophysiology, and sleep hygiene. Prog Cardiovasc Dis 77:59–69. https://doi.org/10.1016/j.pcad.2023.02.005
Shneerson J, Wright J (2001) Lifestyle modification for obstructive sleep apnea. Cochrane Database Syst Rev 1:CD002875. https://doi.org/10.1002/14651858.CD002875
Oksenberg A, Gadoth N, Töyräs J, Leppänen T (2020) Prevalence and characteristics of positional obstructive sleep apnea (POSA) in patients with severe OSA. Sleep Breath 24(2):551–559. https://doi.org/10.1007/s11325-019-01897-1
doi: 10.1007/s11325-019-01897-1
pubmed: 31325020
Smith PL, Gold AR, Meyers DA, Haponik EF, Bleecker ER (1985) Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 103:850–855
doi: 10.7326/0003-4819-103-6-850
pubmed: 3933396
Young T, Skatrud J, Peppard PE (2004) Risk factors for obstructive sleep apnea in adults. JAMA 291(16):2013–2016. https://doi.org/10.1001/jama.291.16.2013
doi: 10.1001/jama.291.16.2013
pubmed: 15113821
Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239. https://doi.org/10.1164/rccm.2109080
doi: 10.1164/rccm.2109080
pubmed: 11991871
Issa FG, Sullivan CE (1982) Alcohol, snoring and sleep apnea. J Neurol Neurosurg Psychiatry 45:353–359
doi: 10.1136/jnnp.45.4.353
pubmed: 7077345
pmcid: 491372
Series F, Roy N, Marc I (1994) Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med 150:481–485
doi: 10.1164/ajrccm.150.2.8049833
pubmed: 8049833
Brown FC, Buboltz WC Jr, Soper B (2002) Relationship of sleep hygiene awareness, sleep hygiene practices and sleep quality in university students. Behav Med 28(1):33–38. https://doi.org/10.1080/08964280209596396
doi: 10.1080/08964280209596396
pubmed: 12244643
Kitamura T, Miyazaki S, Koizumi H, Takeuchi S, Tabata T, Suzuki H (2016) Sleep hygiene education for patients with obstructive sleep apnea. Sleep Biol Rhythm 14:101–106
doi: 10.1007/s41105-015-0015-9
Victor LD (2004) Treatment of obstructive sleep apnea in primary care. Am Fam Physician 69(3):561–568
pubmed: 14971838
Peter HJ (1992) Sleep hygiene, relaxation therapy, and cognitive interventions. In: Hauri PJ (ed) Case studies in insomnia. Plenum, New York, NY, pp 65–84
Jackson M, Collins A, Berlowitz D, Howard M, O’Donoghue F, Barnes M (2015) Efficacy of sleep position modification to treat positional obstructive sleep apnea. Sleep Med 16:545–552. https://doi.org/10.1016/j.sleep.2015.01.008 . (Elsivier)
doi: 10.1016/j.sleep.2015.01.008
pubmed: 25771294
A Review by, Veasey SC, Guilleminault C, Strohl KP et al (2006) Medical therapy for obstructive sleep apnea: a review by the medical therapy for obstructive sleep apnea task force of the standards of practice committee of the American Academy of Sleep Medicine. Sleep 29(8):1036–1044
doi: 10.1093/sleep/29.8.1036
Qureshi A, Lee-Chiong TL Jr (2005) Medical treatment of obstructive sleep apnea. Semin Respir Crit Care Med 26:1
doi: 10.1055/s-2005-864203
American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3a edn. American Academy of Sleep Medicine, Darien, IL
Sánchez AI, Martínez P, Miró E, Bardwell WA, Buela-Casal G (2009) CPAP and behavioral therapies in patients with obstructive sleep apnea: effects on daytime sleepiness, mood, and cognitive function. Sleep Med Rev 13(3):223-e 33. https://doi.org/10.1016/j.smrv.2008.07.002
doi: 10.1016/j.smrv.2008.07.002
pubmed: 19201228
Engleman HM, Martin SE, Deary IJ, Douglas NJ (1994) Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet 343:572–575
doi: 10.1016/S0140-6736(94)91522-9
pubmed: 7906330
Engleman HM, Martin SE, Kingshott RN, Mackay TW, Deary IJ, Douglas NJ (1998) Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome. Thorax 53:341–345
doi: 10.1136/thx.53.5.341
pubmed: 9708223
pmcid: 1745223
Lojander J, Maasilta P, Partinen M, Brander PE, Salmi T, Lehtonen H (1996) Nasal- CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome A randomized study. Chest 110:114–119
doi: 10.1378/chest.110.1.114
pubmed: 8681614
Zhao YY, Wang R, Gleason KJ, Lewis EF, Quan SF, Toth CM, Morrical M, Rueschman M, Weng J, Ware JH, Mittleman MA (2017) Effect of continuous positive airway pressure treatment on health-related quality of life and sleepiness in high cardiovascular risk individuals with sleep apnea: Best Apnea Interventions for Research (BestAIR) Trial. Sleep 40(4):zsx040. https://doi.org/10.1093/sleep/zsx040
doi: 10.1093/sleep/zsx040
pubmed: 28419387
pmcid: 5806548
Barbé F, Durán-Cantolla J, Capote F et al (2010) Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 181:718–726. https://doi.org/10.1164/rccm.200901-0050OC
doi: 10.1164/rccm.200901-0050OC
pubmed: 20007932
Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ (1998) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2:CD001106. https://doi.org/10.1002/14651858.CD001106
Redline S, Adams N, Strauss ME, Roebuck T, Winters M, Rosenberg C (1998) Improvement of mild sleep-disordered breathing with CPAP compared with conservative therapy. AM J Respir Crit Care Med 157:858–865
doi: 10.1164/ajrccm.157.3.9709042
pubmed: 9517603
Monasterio C, Vidal S, Duran J et al (2001) Effectiveness of continuous positive airway pressure in mild sleep apnea–hypopnea syndrome. Am J Respir Crit Care Med 164:939–943
doi: 10.1164/ajrccm.164.6.2008010
pubmed: 11587974
Lee S-A, Paek J-H, Han S-H (2015) Sleep hygiene and its association with daytime sleepiness, depressive symptoms, and quality of life in patients with mild obstructive sleep apnea. J Neurol Sci 359:445–449. https://doi.org/10.1016/j.jns.2015.10.017
doi: 10.1016/j.jns.2015.10.017
pubmed: 26478130
Jung SY, Kim H, Min JY, Hwang KJ, Kim SW (2019) Sleep hygiene-related conditions in patients with mild to moderate obstructive sleep apnea. Auris Nasus Larynx 46:95–100. https://doi.org/10.1016/j.anl.2018.06.003 . (Elsivier)
doi: 10.1016/j.anl.2018.06.003
pubmed: 29934236
Wimms AJ, Kelly JL, Turnbull CD et al (2019) Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial. Lancet Respir Med. https://doi.org/10.1016/S2213-2600(19)30402-3
Lam B, Sam K, Mok WY, Cheung MT, Fong DY, Lam JC, Lam DC, Yam LY, Mary SM (2007) Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnea. Thorax 62:354–359. https://doi.org/10.1136/thx.2006.063644
doi: 10.1136/thx.2006.063644
pubmed: 17121868
Ballester E, Badia JR, Hernández L, Carrasco E, de Pablo J (1999) Consol Fornas, Robert Rodriguez-Roisin, and Josep M. Montserrat. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:495–501
doi: 10.1164/ajrccm.159.2.9804061
pubmed: 9927363
Torres-Castro R, Vilaró J, Martí JD et al (2019) Effects of a combined community exercise program in obstructive sleep apnea syndrome: a randomized clinical trial. J Clin Med 8:361. https://doi.org/10.3390/jcm8030361
doi: 10.3390/jcm8030361
pubmed: 30875753
pmcid: 6463021
Iftikhar IH, Kline CE, Youngstedt SD (2014) Effects of exercise training on sleep apnea: a meta-analysis. Lung 192:175–184
doi: 10.1007/s00408-013-9511-3
pubmed: 24077936
pmcid: 4216726
Mendelson M, Bailly S, Marillier M, Flore P, Borel JC et al (2018) Obstructive sleep apnea syndrome, objectively measured physical activity and exercise training interventions: a systematic review and meta-analysis. Front Neurol 9:73. https://doi.org/10.3389/fneur.2018.00073
Cipriano LHC, Borges YG, Mill JG, Mauad H, Martins de Araujo MT, Gouvea SA (2021) Effects of short-term aerobic training versus CPAP therapy on heart rate variability in moderate to severe OSA patients. Soc Psychophysiological Res Psychophysiol 58:e13771. https://doi.org/10.1111/psyp.13771
doi: 10.1111/psyp.13771
Young T, Peppard PE, Taheri S (1985) Excess weight and sleep-disordered breathing. J Appl Physiol 99(4):1592–9. https://doi.org/10.1152/japplphysiol.00587.2005
doi: 10.1152/japplphysiol.00587.2005
Carneiro-Barrera A, Amaro-Gahete FJ, Guillén-Riquelme A, Jurado-Fasoli L, Sáez-Roca G, Martín-Carrasco C, Buela-Casal G, Ruiz JR (2022) Effect of an interdisciplinary weight loss and lifestyle intervention on obstructive sleep apnea severity: the INTERAPNEA randomized clinical trial. JAMA Netw Open 5(4):e228212. https://doi.org/10.1001/jamanetworkopen.2022.8212
doi: 10.1001/jamanetworkopen.2022.8212
pubmed: 35452108
pmcid: 9034401
Gambino F, Zammuto MM, Virzì A, Conti G, Bonsignore MR (2022) Treatment options in obstructive sleep apnea. Intern Emerg Med 17(4):971–978. https://doi.org/10.1007/s11739-022-02983-1
doi: 10.1007/s11739-022-02983-1
pubmed: 35460431
pmcid: 9135849
Benoist L, de Ruiter M, de Lange J, de Vries N (2017) A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep Med 34:109–117. https://doi.org/10.1016/j.sleep.2017.01.024
doi: 10.1016/j.sleep.2017.01.024
pubmed: 28522078
Kribbs NB, Pack AI, Kline LR et al (1993) Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 147:887–895
doi: 10.1164/ajrccm/147.4.887
pubmed: 8466125
Pepin JL, Krieger J, Rodenstein D et al (1999) Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients. Am J Respir Crit Care Med 160:1124–9
doi: 10.1164/ajrccm.160.4.9802027
pubmed: 10508797
Engleman HM, Wild MR (2003) Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev 7:81–99
doi: 10.1053/smrv.2001.0197
pubmed: 12586532
Yingjuan M, Siang WH, Leong Alvin TK, Poh HP (2020Jun) Positional therapy for positional obstructive sleep apnea. Sleep Med Clin 15(2):261–275. https://doi.org/10.1016/j.jsmc.2020.02.012
doi: 10.1016/j.jsmc.2020.02.012
pubmed: 32386700
Dalmases M, Solé-Padullés C, Torres M et al (2015) Effect of CPAP on cognition, brain function, and structure among elderly patients with OSA - a randomized pilot study. Chest 148(5):1214–1223 (ClinicalTrials.gov; No.: NCT01826032)
doi: 10.1378/chest.15-0171
pubmed: 26065720
Daurat A, Huet N, Tiberge M (2010) Metamemory beliefs and episodic memory in obstructive sleep apnea syndrome. Psychol Rep 107:289–302
doi: 10.2466/10.13.20.22.PR0.107.4.289-302
pubmed: 20923074
Bédard M, Montplaisir J, Richer F, Rouleau I, Malo J (1991) Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychol 13:950–964
doi: 10.1080/01688639108405110
pubmed: 1779033
Chen CW, Yang CM, Chen NH (2012) Objective versus subjective cognitive functioning in patients with obstructive sleep apnea. Open Sleep J 5:33–42
doi: 10.2174/1874620901205010033
Salorio CF, White DA, Piccirillo J, Duntley SP, Uhles ML (2002) Learning, memory, and executive control in individuals with obstructive sleep apnea syndrome. J Clin Exp Neuropsychol 24(1):93–100. https://doi.org/10.1076/jcen.24.1.93.973
doi: 10.1076/jcen.24.1.93.973
pubmed: 11935427
Kielb SA, Ancoli-Israel S, Rebok GW, Spira AP (2012) Cognition in obstructive sleep apnea-hypopnea syndrome (OSAS): current clinical knowledge and the impact of treatment. Neuromol Med 4(3). https://doi.org/10.1007/s12017-012-8182-1
Alvarez JA, Emory E (2006) Executive function and the frontal lobes: a meta-analytic review. Neuropsychol Rev 16:17–42
doi: 10.1007/s11065-006-9002-x
pubmed: 16794878
Saunamäki T, Himanen SL, Polo O, Jehkonen M (2009) Executive dysfunction in patients with obstructive sleep apnea syndrome. Eur Neurol 62:237–242
doi: 10.1159/000232156
pubmed: 19672077
Vaessen Tim JÁ, Overeem S, Sitskoorn MM (2015) Cognitive complaints in obstructive sleep apnea. Sleep Med Rev 19:51–58. https://doi.org/10.1016/j.smrv.2014.03.008
doi: 10.1016/j.smrv.2014.03.008
pubmed: 24846772
Barnes M, Houston D, Worsnop J et al (2002) A randomised controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med 165(773–80):39
Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG, Vowles N et al (2004) Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170:656–664
doi: 10.1164/rccm.200311-1571OC
pubmed: 15201136
Doherty LS, Kiely JL, Lawless G, McNicholas WT (2003) Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners of patients with obstructive sleep apnea syndrome. Chest 124(2209–14):63
Akashiba T, Kawahara S, Akahoshi T et al (2002) Relationship between quality of life and mood or depression in patients with severe obstructive sleep apnea syndrome. Chest 122:861–865
doi: 10.1378/chest.122.3.861
pubmed: 12226024
Borak J, Cieslicki JK, Koziej M, Matuszewski A, Zielinski J (1996) Effects of CPAP treatment on psychological status in patients with severe obstructive sleep apnoea. J Sleep Res 5(123–7):22