Hypnotics on Obstructive Sleep Apnea Severity and Endotypes: A Systematic Review and Meta-Analysis.

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE

American journal of respiratory and critical care medicine Pub Date : 2024-12-15 DOI:10.1164/rccm.202403-0501OC

Ludovico Messineo, Scott A Sands, Gonzalo Labarca

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引用次数: 0

Abstract

Rationale: Low arousal threshold and poor muscle responsiveness are common determinants of obstructive sleep apnea (OSA). Hypnotics were hypothesized as an alternative OSA treatment via raising the arousal threshold and possibly genioglossus responsiveness. Objectives: To examine the effect of common hypnotics on arousal threshold, OSA severity, and genioglossus responsiveness. Methods: We searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov for randomized clinical trials, and we ran meta-analyses to determine the effect of oral hypnotics on arousal threshold, OSA severity, and genioglossus responsiveness. The Grades of Recommendation Assessment, Development and Evaluation was used to rate the quality of evidence (QoE). The association between post-treatment apnea-hypopnea index (AHI) and arousal threshold percentage reductions was explored in individual patient data meta-analyses (overall sample and low arousal threshold subgroups). Measurements and Main Results: On the basis of our analysis (27 studies; 25 for AHI, 11 for arousal threshold, 4 for genioglossus responsiveness), hypnotics minimally raised arousal threshold (mean difference [95% confidence interval], 2.7 [1.5, 3.8] cm H₂O epiglottic pressure swings; moderate QoE) but did not change OSA severity (-1.4 [-3.5, 0.7] events/h; moderate QoE). Individual patient data meta-analysis (N = 114) showed no association between changes in arousal threshold and AHI, independent of arousal threshold subgrouping. However, people with very low arousal threshold or those who exhibited a 0-25% arousal threshold increase from placebo experienced the greatest, yet still modest, post-treatment AHI reductions (∼10%). Hypnotics did not affect genioglossus responsiveness (high QoE). Conclusions: Further research testing or clinical use of hypnotics as OSA alternative treatments should be discouraged, unless in the presence of comorbid insomnia or as part of combination therapy in individuals with very low arousal threshold.

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催眠药对阻塞性睡眠呼吸暂停严重程度和内型的影响：系统回顾与元分析》。

理由唤醒阈值低和肌肉反应性差是阻塞性睡眠呼吸暂停（OSA）的常见决定因素。催眠药被认为是通过提高唤醒阈值和可能的舌根肌反应性来治疗 OSA 的一种替代方法：常用催眠药对唤醒阈值、OSA 严重程度和舌根反应性的影响：我们检索了MEDLINE、EMBASE、CENTRAL和ClinicalTrials.gov的随机临床试验，并进行了荟萃分析，以确定口服催眠药对唤醒阈值、OSA严重程度和舌根反应性的影响。采用 GRADE 对证据质量（QoE）进行评分。在单个患者数据（IPD）元分析（总体样本和低唤醒阈值亚组）中探讨了治疗后 AHI 与唤醒阈值百分比降低之间的关联：根据我们的分析（27 项研究；25 项针对 AHI，11 项针对唤醒阈值，4 项针对舌根舌骨反应性），催眠药可最小程度地提高唤醒阈值（平均差[95% CI]：2.7 [1.5, 3.8] cmH2O 会厌压力波动；中度 QoE），但不会改变 OSA 的严重程度（1.4 [3.5, 0.7] 事件/小时；中度 QoE）。IPD荟萃分析（N=114）显示，唤醒阈值的变化与AHI之间没有关联，与低唤醒阈值亚组无关。然而，唤醒阈值极低或唤醒阈值比安慰剂增加 0-25% 的人，治疗后 AHI 降低幅度最大，但仍然适中（10%）。催眠药不影响舌根部的反应能力（高QoE）：结论：除非存在合并失眠症或作为唤醒阈值极低的个体的联合疗法的一部分，否则应阻止将催眠药作为 OSA 替代疗法进行进一步的研究测试或临床使用。

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来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.