Cochrane Database of Systematic Reviews最新文献

{"title":"Interventions for idiopathic steroid-resistant nephrotic syndrome in children.","authors":"Isaac D Liu, Narelle S Willis, Jonathan C Craig, Elisabeth M Hodson","doi":"10.1002/14651858.CD003594.pub7","DOIUrl":"10.1002/14651858.CD003594.pub7","url":null,"abstract":"<p><strong>Background: </strong>Nephrotic syndrome is a condition in which the glomeruli of the kidney leak large amounts of protein from the blood into the urine. Most children who present with their first episode of nephrotic syndrome achieve remission with corticosteroids. Children who fail to respond to corticosteroids in the first episode of nephrotic syndrome (initial resistance) or develop resistance after one or more responses to corticosteroids (delayed resistance) may be treated with immunosuppressive agents, including calcineurin inhibitors (cyclosporin or tacrolimus), and with non-immunosuppressive agents, such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. However, response to these agents is limited, so newer agents, including anti-CD20 antibodies (rituximab, ofatumumab) and dual endothelin-angiotensin receptor antagonists (sparsentan), are being assessed for efficacy and safety. This is an update of a review first published in 2004 and updated in 2006, 2010, 2016 and 2019.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of different interventions used in children with idiopathic nephrotic syndrome, who do not achieve remission following four weeks or more of daily corticosteroid therapy.</p><p><strong>Search methods: </strong>The Cochrane Kidney and Transplant (CKT) Information Specialist searched the CKT Register of Studies to 28 January 2025 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE and Embase, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) and quasi-RCTs that compared different immunosuppressive or non-immunosuppressive agents with placebo, prednisone or another agent given orally or parenterally in children aged three months to 18 years with steroid-resistant nephrotic syndrome (SRNS). We included studies that enrolled children and adults, in which paediatric data could not be separated from adult data.</p><p><strong>Data collection and analysis: </strong>Two review authors independently screened the search results, determined study eligibility, assessed risk of bias and extracted study data. We expressed dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs), and continuous outcomes as mean differences (MDs) with 95% CIs. We used a random-effects model to pool data, and GRADE to assess the certainty of the evidence. The main outcomes of interest were treatment response (complete, partial, or complete or partial remission), kidney failure and adverse events.</p><p><strong>Main results: </strong>We included 29 studies (1248 evaluated children). Sixteen studies were at low risk of bias for sequence generation and allocation concealment. Seven and 21 studies were at low risk of performance and detection bias, respec","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD003594"},"PeriodicalIF":8.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton pump inhibitors for the prevention of non-steroidal anti-inflammatory drug-induced ulcers and dyspepsia.","authors":"Luis Garegnani, Gisela Oltra, Mariana Andrea Burgos, Diego Ivaldi, Lucia B Varela, Samanta Díaz Menai, Miguel Puga-Tejada, Camila Micaela Escobar Liquitay, Juan Va Franco","doi":"10.1002/14651858.CD014585.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD014585.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed medicines, commonly used to mitigate pain, inflammation, and cardiovascular prevention, among others. Chronic NSAID consumption increases the risk of acute renal failure, stroke, myocardial infarction, and gastrointestinal toxicity, ranging from mild dyspepsia to serious ulcer complications such as bleeding, obstruction, and perforation. Proton pump inhibitors (PPIs) may exert a gastroprotective effect from NSAID gastroduodenal injury by reducing gastric acid secretion.</p><p><strong>Objectives: </strong>To assess the effects of proton pump inhibitors on the prevention of dyspepsia and ulcers in people with chronic consumption of non-steroidal anti-inflammatory drugs.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), and two trial registers up to 23 October 2023, as well as reference checking, citation searching, and contact with study authors to identify additional studies.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and cluster-RCTs comparing PPIs taken orally versus placebo, histamine 2-receptor antagonists, misoprostol, or sucralfate in adults and children with chronic consumption of NSAIDs for four weeks or longer.</p><p><strong>Outcomes: </strong>Our outcomes were global symptoms of dyspepsia, incident ulcer, adverse events, ulcer complications, and quality of life.</p><p><strong>Risk of bias: </strong>We used the Cochrane RoB 2 tool for RCTs and the tool extension for cluster-RCTs.</p><p><strong>Synthesis methods: </strong>We conducted meta-analyses using random-effects models to calculate risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes and mean differences (MD) and 95% CIs for continuous outcomes. Due to statistical heterogeneity, we conducted meta-analyses for all but two outcomes. We summarised the certainty of evidence according to GRADE methods.</p><p><strong>Included studies: </strong>We included 12 studies with 8760 participants. All studies were conducted in an outpatient setting in Africa, Asia, Europe, North America, Central America, South America, and Australia. They were published between 1996 and 2014. All studies measured outcomes in the short term (up to 12 months).</p><p><strong>Synthesis of results: </strong>PPI versus placebo PPIs may have little to no effect on global symptoms of dyspepsia assessed as a dichotomous outcome, but the evidence is very uncertain (meta-analysis was not possible due to high and unexplained statistical heterogeneity and point estimates of RR ranged from 0.36 to 1.13; 8 studies; 4944 participants; very low-certainty evidence). PPIs probably result in a slight reduction in global symptoms of dyspepsia assessed as a continuous outcome (MD -0.56, 95% CI -0.74 to -0.38; 2 studies, 1149 participants; moderate-certainty evidence). PPIs probably result in a reduction in","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD014585"},"PeriodicalIF":8.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors for return to work in breast cancer survivors.","authors":"Sietske J Tamminga, Astrid de Wind, Michiel A Greidanus, Pieter Coenen, Emilie Friberg, Hester S A Oldenburg, Saskia Fa Duijts, Angela Gem de Boer","doi":"10.1002/14651858.CD015124.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD015124.pub2","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most common type of cancer in women around the world. Large numbers of people diagnosed with breast cancer are working at the time of diagnosis. Accumulating evidence suggests that breast cancer survivors participate less often in paid work compared to others. Return to work among breast cancer survivors is multifactorial. It is currently unknown which factors are associated with return to work in breast cancer survivors. Therefore, it is important to systematically review and synthesize the literature on the association between sociodemographic, breast cancer-related, other health-related, personal, and work-related factors and return to work in this group of people.</p><p><strong>Objectives: </strong>The objective is to systematically review and synthesize the literature on the association between sociodemographic, breast cancer-related, other health-related, personal, and work-related factors and return to work in the 24 months following breast cancer diagnosis among breast cancer survivors having paid work at the time of diagnosis.</p><p><strong>Search methods: </strong>The search strategy included electronic searches in OVID/MEDLINE, Embase.com, EBSCOhost/CINAHL with Full Text, EBSCOhost/PsycINFO, Clarivate Analytics/Web of Science Core Collection and Wiley/Cochrane Library from inception up to 20 January 2023, as well as handsearching references of relevant reviews, included studies, and Google Scholar.</p><p><strong>Selection criteria: </strong>The following inclusion criteria were applied: - The type of study is a prospective cohort study, retrospective cohort study with time lag between assessment of prognostic factor and outcome, or prognosis study based on a randomized controlled trial. - The study sample included people diagnosed with breast cancer, having paid work at the time of their breast cancer diagnosis. - At least one variable as specified in our variable framework was studied. - Return to work (yes/no), or time to return to work was assessed somewhere between one and 24 months of follow-up. - The article type is an original research article (commentaries, reviews, and editorials were excluded). - Full text of the article is available. - The article was published in a peer-reviewed journal.</p><p><strong>Data collection and analysis: </strong>Study characteristics and estimates of unadjusted and adjusted associations between one of the variables from the pre-defined variable framework and return to work were extracted. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. When at least four adjusted or four unadjusted measures of association (e.g. Odds Ratio (OR)) were available and more or less comparable in terms of how the measures of association were included in the analysis of the original study, a meta-analysis was conducted.</p><p><strong>Main results: </strong>The systematic searches yielded 14,799 records with 2 identified via other sources.","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015124"},"PeriodicalIF":8.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain and sedation management for screening or treatment of retinopathy of prematurity.","authors":"Emma Olsson, Olga Romantsik, Pia Lundgren, Michelle Fiander, Alexandra Snellman, Ann Hellstrom, Matteo Bruschettini","doi":"10.1002/14651858.CD016171","DOIUrl":"https://doi.org/10.1002/14651858.CD016171","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of pain and sedation management for screening or treatment of retinopathy of prematurity in preterm infants compared to placebo, no intervention, or other interventions.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016171"},"PeriodicalIF":8.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motor interventions initiated prior hospital discharge to prevent neurodevelopmental impairment in preterm infants.","authors":"Anna Badura, Jana Hiekel, Agustina Saladino, Delfina Murature, Mikaela Lenells, Michelle Fiander, Sven Wellmann, Matteo Bruschettini","doi":"10.1002/14651858.CD016170","DOIUrl":"https://doi.org/10.1002/14651858.CD016170","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of motor interventions initiated prior hospital discharge to prevent neurodevelopmental and motor impairment in preterm infants compared to standard care, post-discharge motor interventions, and different modalities of the same motor intervention.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016170"},"PeriodicalIF":8.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-economic equity in the impact of population-based interventions to reduce alcohol consumption.","authors":"Mandy Roheger, Diana Gürtler, Jennifer Eidswick, Till Ittermann, Jennis Freyer-Adam, Sophie Baumann","doi":"10.1002/14651858.CD016015","DOIUrl":"https://doi.org/10.1002/14651858.CD016015","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the differential effects of public health interventions aimed at reducing alcohol consumption in the general population across SEP as defined by education, occupation, or income. Outcomes will be evaluated using the RE-AIM framework, considering dimensions of reach, effectiveness, adoption, implementation, and maintenance.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016015"},"PeriodicalIF":8.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of out-of-office versus in-office blood pressure monitoring in adults with hypertension.","authors":"Victoria Roncal-Belzunce, Fernanda Ramón-Espinoza, Marta Gutiérrez-Valencia, Leire Leache, Luis Carlos Saiz, Juan Erviti","doi":"10.1002/14651858.CD015304","DOIUrl":"https://doi.org/10.1002/14651858.CD015304","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of out-of-office compared to in-office blood pressure (BP) monitoring for improving clinical outcomes in adults with hypertension.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015304"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Typhoid conjugate vaccines for preventing typhoid fever (enteric fever).","authors":"Natasha R Gloeck, Trudy D Leong, Mashudu Mthethwa, Chinwe Juliana Iwu-Jaja, Patrick Dmc Katoto, Charles S Wiysonge, Tamara Kredo","doi":"10.1002/14651858.CD015746.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD015746.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Typhoid fever is a major cause of enteric disease-related morbidity and mortality. Vaccination reduces disease burden and prevents outbreaks, but policies and programmes should be informed by the most recent evidence as newer vaccines become available.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of typhoid conjugate vaccines (TCVs) compared to no vaccine, placebo, typhoid-inactive agents (vaccines for another disease) or other typhoid vaccines for preventing morbidity and mortality associated with typhoid fever in adults and children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;In April 2024, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Global Index Medicus, United States Advisory Committee on Immunization Practices and the World Health Organization vaccine repository for randomised controlled trials (RCTs), with no restrictions. We also searched clinical trial registries for ongoing trials (www.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinicaltrials: &lt;/strong&gt;gov and the WHO International Clinical Trials Registry Platform), grey literature, bibliographic citations of reviews and key articles for additional studies. We contacted study authors for information about ongoing studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included RCTs and cluster-RCTs of children and adults living in typhoid-endemic areas or travelling to typhoid-endemic areas. We included studies comparing TCVs to controls (i.e. no vaccine, placebo or vaccines for another disease), non-conjugated typhoid vaccines or other TCVs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Outcomes included acute typhoid fever, defined by laboratory-confirmed isolation of Salmonella typhi, all-cause mortality, adverse events (AEs) and serious adverse events (SAEs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Review authors independently assessed risk of bias for all outcomes, using the Cochrane RoB 2 tools. We resolved disagreements through discussion or adjudication. We assessed the intention-to-treat effect and used the overall RoB judgement to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Three review authors independently screened titles and abstracts for eligible studies, followed by full-text assessment. Disagreements were resolved through discussion or adjudication by a fourth author. Four authors independently extracted characteristics of included studies and outcome data using a piloted, standardised data extraction form. We synthesised results for each outcome where possible, using the Mantel-Haenszel statistical method and random-effects analysis model. Where meta-analysis was not possible due to the nature of the data, we planned to synthesise results based on direction of effect. We used GRADE to assess the certainty of evidence for each outcome, assessing risk of bias, inconsistency, indirectness, imprecision and other bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 19 t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015746"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Approaches to Stop Hypertension (DASH) for the primary and secondary prevention of cardiovascular diseases.","authors":"Abdelsalam Bensaaud, Suzanne Seery, Irene Gibson, Jennifer Jones, Gerard Flaherty, John William McEvoy, Fionnuala Jordan, Wael Tawfick, Sherif Ah Sultan","doi":"10.1002/14651858.CD013729.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD013729.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Dietary Approaches to Stop Hypertension (DASH) diet is designed to lower blood pressure and improve cardiovascular health by reducing sodium and unhealthy fats while increasing nutrients, including potassium, calcium, magnesium, and fibre. While evidence supports its benefits for managing cardiovascular risk factors, gaps remain in understanding its long-term impact on preventing cardiovascular disease (CVD), particularly in terms of hard clinical outcomes such as myocardial infarction and stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of the DASH diet for the primary and secondary prevention of cardiovascular diseases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We used standard extensive Cochrane search methods. The latest search date was in May 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing a DASH diet intervention to no intervention (including usual care), minimal intervention, or other dietary interventions. In the context of this review, 'minimal intervention' includes brief dietary advice or informational leaflets provided during a medical consultation, without a structured dietary intervention. 'Other dietary interventions' include any other dietary programme besides the DASH diet. Participants were adults with or without CVD. The minimum duration of eligible interventions was eight weeks and the minimum follow-up was three months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methods. Primary outcomes were myocardial infarction, heart failure, and stroke. Secondary outcomes were the need for coronary revascularisation, carotid revascularisation, peripheral revascularisation, all-cause mortality, cardiovascular mortality, changes in blood pressure, blood lipids, the occurrence of type 2 diabetes, health-related quality of life, and adverse effects. We used GRADE to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;Five RCTs involving 1397 participants met our inclusion criteria and were included in this review. All five trials contributed at least one intervention arm to one or more of the three prespecified comparisons. In total, 1075 participants across eligible arms were included in the meta-analyses. The difference reflects trial arms that did not meet our prespecified intervention and comparison definitions, and were therefore not analysed, though all participants were randomised within eligible trials and are accounted for in the review total. The trials assessed the DASH diet in a primary prevention setting; none evaluated its effects in secondary prevention. Participants were generally healthy adults aged 18 years or older, without diagnosed cardiovascular disease. The intervention duration ranged from 16 weeks to 12 months, with follow-up periods between 16 weeks and 18 months (medium- and long-term). The trials were conducted in the USA and Poland, wit","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD013729"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of limited channel sleep studies versus polysomnography for obstructive sleep apnoea.","authors":"Sander van Doorn, Demy L Idema, Pauline Heus, Johanna Aag Damen, René Spijker, Eva J Japenga, Herre J Reesink, Lotty Hooft","doi":"10.1002/14651858.CD013810.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD013810.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obstructive sleep apnoea (OSA) is a common cause of sleep disturbance, characterised by the presence of repetitive upper airway obstruction during sleep. OSA is associated with sleepiness during the day, reduced quality of life and an increased risk of cardiovascular disease. OSA can be diagnosed using several different strategies. The current reference test is fully supervised polysomnography, which is expensive and time-consuming. Other diagnostic tests, referred to as limited channel sleep studies because they include fewer parameters than polysomnography, are less resource-intensive but may also have different diagnostic performances, resulting in a difference in clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the clinical impact (outcome on a participant level) of a strategy where treatment follows diagnostic testing (test-treatment combination) using limited channel sleep studies compared to polysomnography in people with suspected obstructive sleep apnoea (OSA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched two databases (CENTRAL, MEDLINE) up to 11 May 2023 using search terms related to OSA and polysomnography developed by our information specialist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials that compared any limited channel sleep studies with Level I fully supervised polysomnography in adults (aged 18 years and older) with suspected OSA. Our primary outcome was sleepiness, and our secondary outcomes were quality of life, all-cause mortality, cardiovascular events and correlating risk factors, continuous positive airway pressure (CPAP) usage, serious adverse events, and cost-effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Four review authors extracted data from the included trials and assessed the risk of bias. We summarised treatment effects using random-effects meta-analyses and expressed as mean difference (MD) or standardised mean difference (SMD) with corresponding 95% confidence intervals (CI) where possible. We used GRADE to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included three trials with 1143 participants. One trial compared Level III sleep studies to a Level I fully supervised polysomnography, one trial compared Level IV sleep studies to Level I sleep studies, and one trial compared Level IV sleep studies versus Level III sleep studies versus Level I sleep studies. The follow-up of these trials ranged from four to six months. Level III sleep studies versus Level I sleep studies There is high-certainty evidence that Level III sleep studies result in little to no difference in sleepiness (MD 0.47, 95% CI -0.23 to 1.18; P = 0.19, I&lt;sup&gt;2&lt;/sup&gt; = 0%; 2 trials, 701 participants) or quality of life (SMD 0.01, 95% CI -0.14 to 0.16; P = 0.93, I&lt;sup&gt;2&lt;/sup&gt; = 0%; 2 trials, 701 participants) compared to Level I sleep studies. Level III sleep studies are also probably slightly more cost-ef","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD013810"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}