TY - JOUR
T1 - Comparative efficacy of CPAP, MADs, exercise-training, and dietary weight loss for sleep apnea
T2 - a network meta-analysis
AU - Iftikhar, Imran H.
AU - Bittencourt, Lia
AU - Youngstedt, Shawn
AU - Ayas, Najib
AU - Cistulli, Peter
AU - Schwab, Richard
AU - Durkin, Martin W.
AU - Magalang, Ulysses J.
N1 - Publisher Copyright:
© 2016 Elsevier B.V.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Study objective To synthesize evidence from available studies on the relative efficacies of continuous positive airway pressure (CPAP), mandibular advancement device (MAD), supervised aerobic exercise training, and dietary weight loss in patients with obstructive sleep apnea (OSA). Design Network meta-analysis of 80 randomized controlled trials (RCTs) short-listed from PubMed, SCOPUS, Web of science, and Cochrane register (inception – September 8, 2015). Patients Individuals with OSA. Interventions CPAP, MADs, exercise training, and dietary weight loss. Results CPAP decreased apnea–hypopnea index (AHI) the most [by 25.27 events/hour (22.03–28.52)] followed by exercise training, MADs, and dietary weight loss. While the difference between exercise training and CPAP was non-significant [−8.04 (−17.00 to 0.92), a significant difference was found between CPAP and MADs on AHI and oxygen desaturation index (ODI) [−10.06 (−14.21 to −5.91) and −7.82 (−13.04 to −2.59), respectively]. Exercise training significantly improved Epworth sleepiness scores (ESS) [by 3.08 (0.68–5.48)], albeit with a non-significant difference compared to MADs and CPAP. Conclusions CPAP is the most efficacious in complete resolution of sleep apnea and in improving the indices of saturation during sleep. While MADs offer a reasonable alternative to CPAP, exercise training which significantly improved daytime sleepiness (ESS) could be used as adjunctive to the former two.
AB - Study objective To synthesize evidence from available studies on the relative efficacies of continuous positive airway pressure (CPAP), mandibular advancement device (MAD), supervised aerobic exercise training, and dietary weight loss in patients with obstructive sleep apnea (OSA). Design Network meta-analysis of 80 randomized controlled trials (RCTs) short-listed from PubMed, SCOPUS, Web of science, and Cochrane register (inception – September 8, 2015). Patients Individuals with OSA. Interventions CPAP, MADs, exercise training, and dietary weight loss. Results CPAP decreased apnea–hypopnea index (AHI) the most [by 25.27 events/hour (22.03–28.52)] followed by exercise training, MADs, and dietary weight loss. While the difference between exercise training and CPAP was non-significant [−8.04 (−17.00 to 0.92), a significant difference was found between CPAP and MADs on AHI and oxygen desaturation index (ODI) [−10.06 (−14.21 to −5.91) and −7.82 (−13.04 to −2.59), respectively]. Exercise training significantly improved Epworth sleepiness scores (ESS) [by 3.08 (0.68–5.48)], albeit with a non-significant difference compared to MADs and CPAP. Conclusions CPAP is the most efficacious in complete resolution of sleep apnea and in improving the indices of saturation during sleep. While MADs offer a reasonable alternative to CPAP, exercise training which significantly improved daytime sleepiness (ESS) could be used as adjunctive to the former two.
KW - Aerobic exercise training
KW - Continuous positive airway pressure
KW - Dietary weight loss
KW - Mandibular advancement device
KW - Network meta-analysis
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U2 - 10.1016/j.sleep.2016.06.001
DO - 10.1016/j.sleep.2016.06.001
M3 - Article
C2 - 28215266
AN - SCOPUS:85007137564
SN - 1389-9457
VL - 30
SP - 7
EP - 14
JO - Sleep Medicine
JF - Sleep Medicine
ER -