Comparative efficacy of non-pharmacological interventions for adults with sleep apnea: A systematic review and network meta-analysis

作者：Spyridon N. Papageorgiou, Ioannis Konstantinidis, Alexandra K. Papadopoulou, Fani Apostolidou-Kiouti, Ioannis Avgerinos, Athanasia Pataka, Theodore Eliades, Απόστολος Τσάπας, Anna‐Bettina Haidich · 发表于：Sleep Medicine · 年份：2025 · DOI：10.1016/j.sleep.2025.02.008 · 被引用次数：14 · 研究领域：Obstructive Sleep Apnea Research、Sleep and related disorders、Restless Legs Syndrome Research

BACKGROUND: Sleep apnea is associated with cardiovascular risk, work productivity, occupational/traffic accidents, and quality-of-life (QoL); however uncertainty exists regarding optimal treatment. We performed a systematic review on the efficacy of non-pharmacological interventions for adults with sleep apnea. METHOD: We searched MEDLINE, Scopus, Virtual-Health-Library and Web-of-Science through June 2023 for parallel/cross-over randomized trials on adults with sleep apnea (apnea-hypopnea-index>5 events/hour). Study selection, data extraction and risk-of-bias assessment were performed in duplicate, followed by frequentist network meta-analyses. RESULTS: Ultimately, 197 unique trials were included (15,931 patients; mean age 51.4 years; 78.9 % male) assessing 25 treatments. Positive Airway Pressure (PAP) (alone or combined with health behaviour modification) consistently improved more apnea-hypopnea-index or daytime sleepiness and physical/mental QoL in obstructive sleep apnea (OSA) patients compared to all other interventions but was not always well-tolerated. Mandibular advancement devices (MAD) yielded the greatest improvement in depression, while also improving objective/subjective apnea-outcomes, and physical/mental QoL-albeit less than PAP and less for moderate/severe cases. Acupuncture, health behaviour modifications, surgical maxillomandibular advancement, minor oral surgery, oropharyngeal training, oxygen supplementation, or electrical neurostimulation might improve a...