Seyed Sina Neshat , Afshin Heidari , Mario Henriquez-Beltran , Kripa Patel , Brendon Colaco , Vichaya Arunthari , Alejandra Yu Lee Mateus , Joseph Cheung , Gonzalo Labarca
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Finally, a network meta-analysis synthesized direct and indirect evidence, followed by a comprehensive safety analysis. We included 32 articles in the meta-analysis (n = 3357). Pharmacotherapy showed a significant improvement in the Epworth Sleepiness Scale (ESS) score (Mean Difference (MD) −2.73, (95 % Confidence Interval (CI) [−3.25, −2.20], p < 0.01) and Maintenance of Wakefulness Test (MWT) score (MD 6.00 (95 % CI [2.66, 9.33] p < 0.01). Solriamfetol, followed by Pitolisant and modafinil, exhibited the greatest ESS reduction, while Danavorexton, followed by Solriamfetol and MK-7288, had the strongest impact on MWT. MK-7288 had the most total adverse events (AEs), followed by Danavorexton and armodafinil. Pharmacological Interventions significantly alleviate EDS in OSA patients but with heterogeneity across medications. 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引用次数: 0
摘要
阻塞性睡眠呼吸暂停(OSA)与白天过度嗜睡(EDS)有关。药物疗法是治疗 OSA 患者 EDS 的一种潜在方法。本系统综述和荟萃分析旨在评估药物干预对减轻 OSA 患者 EDS 的疗效和安全性。根据 PRISMA 指南,我们纳入了 2023 年 8 月之前调查成人 OSA EDS 药物治疗的随机对照试验。我们采用随机效应模型进行了荟萃分析、亚组分析和元回归分析。最后,网络荟萃分析综合了直接和间接证据,并进行了全面的安全性分析。我们在荟萃分析中纳入了 32 篇文章(n = 3357)。药物治疗可显著改善埃普沃思嗜睡量表(ESS)评分(平均差(MD)-2.73,(95 % 置信区间(CI)[-3.25,-2.20],p < 0.01)和保持清醒测试(MWT)评分(MD 6.00,(95 % CI [2.66,9.33] p < 0.01)。Solriamfetol 对ESS 的降低幅度最大,其次是 Pitolisant 和 modafinil,而 Danavorexton 对 MWT 的影响最大,其次是 Solriamfetol 和 MK-7288。MK-7288 的总不良事件(AEs)最多,其次是达那伐他汀和阿莫达非尼。药物干预能明显缓解 OSA 患者的 EDS,但不同药物之间存在差异。治疗决策应包括对患者因素和预期结果的个性化评估。
Evaluating pharmacological treatments for excessive daytime sleepiness in obstructive sleep apnea: A comprehensive network meta-analysis and systematic review
Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness (EDS). Pharmacotherapy offers a potential treatment approach for EDS in OSA patients. This systematic review and meta-analysis aimed to assess the efficacy and safety of pharmacological interventions for alleviating EDS in patients with OSA. Following PRISMA guidelines, we included randomized controlled trials investigating pharmacological treatments for EDS in adult OSA until August 2023. We conducted meta-analysis, subgroup, and meta-regression analyses using a random effects model. Finally, a network meta-analysis synthesized direct and indirect evidence, followed by a comprehensive safety analysis. We included 32 articles in the meta-analysis (n = 3357). Pharmacotherapy showed a significant improvement in the Epworth Sleepiness Scale (ESS) score (Mean Difference (MD) −2.73, (95 % Confidence Interval (CI) [−3.25, −2.20], p < 0.01) and Maintenance of Wakefulness Test (MWT) score (MD 6.00 (95 % CI [2.66, 9.33] p < 0.01). Solriamfetol, followed by Pitolisant and modafinil, exhibited the greatest ESS reduction, while Danavorexton, followed by Solriamfetol and MK-7288, had the strongest impact on MWT. MK-7288 had the most total adverse events (AEs), followed by Danavorexton and armodafinil. Pharmacological Interventions significantly alleviate EDS in OSA patients but with heterogeneity across medications. Treatment decisions should involve a personalized assessment of patient factors and desired outcomes.
期刊介绍:
Sleep Medicine Reviews offers global coverage of sleep disorders, exploring their origins, diagnosis, treatment, and implications for related conditions at both individual and public health levels.
Articles comprehensively review clinical information from peer-reviewed journals across various disciplines in sleep medicine, encompassing pulmonology, psychiatry, psychology, physiology, otolaryngology, pediatrics, geriatrics, cardiology, dentistry, nursing, neurology, and general medicine.
The journal features narrative reviews, systematic reviews, and editorials addressing areas of controversy, debate, and future research within the field.