Efficacy of CPAP duration and adherence for cognitive improvement in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials,Sleep and Breathing

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Efficacy of CPAP duration and adherence for cognitive improvement in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials
Sleep and Breathing ( IF 2.1 ) Pub Date : 2022-08-05 , DOI: 10.1007/s11325-022-02687-y
Jiaxin Li _{1,

2,

3} , Wenjie Yan _{1,

2,

3} , Minhan Yi _{1,

4} , Ruihan Lin _{1,

2,

3} , Zini Huang ₅ , Yuan Zhang _{1,

2}

Affiliation

Purpose

Obstructive sleep apnea (OSA) can impair cognition. Continuous positive airway pressure (CPAP) is a recommended treatment for OSA but its effectiveness on cognitive improvement is uncertain, a finding which may be biased by various durations and adherence to treatment with CPAP. In a meta-analysis assessing high-quality randomized controlled trials (RCTs), we estimated whether or not CPAP benefits cognition in patients with OSA.

Methods

PRISMA criteria were followed in the performance of this meta-analysis. The weighted mean difference (WMD) and 95% confidence interval (CI) of six neuropsychological scores covering eight cognitive domains were used to evaluate the benefit between CPAP and non-CPAP interventions. Subgroups of different therapeutic durations and adherence, which were divided into short-term (< 8 weeks) and long-term (≥ 12 weeks) durations, and poor (nighttime < 4 h/night) and good (nighttime ≥ 4 h/night) adherence were also analyzed.

Results

Among 16 RCTs, 1529 participants with OSA were included. Comparing the CPAP group and the control group for all treatment durations and adherence, a mild improvement for digit span forward which reflected short-term memory was observed (WMD[95%CI] = 0.67[0.03,1.31], p = 0.04). Trail making test-part B, which reflected executive function was improved for participants with OSA who had good adherence to CPAP (WMD[95%CI] = − 6.24[− 12.60,0.12], p = 0.05). Patients with OSA who received short-term CPAP treatment (WMD[95%CI] = − 7.20[− 12.57, − 1.82], p = 0.009) had a significant improvement in executive function when compared with controls. There was no statistical difference for all scales between long-term (≥ 12 weeks) CPAP treatment group and control group.

Conclusion

The effectiveness of CPAP on cognitive improvement in patients with OSA is limited, although good adherence to CPAP can mildly benefit executive function with short-term effectiveness.

中文翻译：

CPAP 持续时间和依从性对阻塞性睡眠呼吸暂停患者认知改善的疗效：随机对照试验的荟萃分析

目的

阻塞性睡眠呼吸暂停 (OSA) 会损害认知。持续气道正压通气 (CPAP) 是 OSA 的推荐治疗方法，但其对认知改善的有效性尚不确定，这一发现可能因持续时间和 CPAP 治疗的依从性不同而存在偏差。在一项评估高质量随机对照试验 (RCT) 的荟萃分析中，我们评估了 CPAP 是否有益于 OSA 患者的认知。

方法

执行此荟萃分析时遵循 PRISMA 标准。涵盖八个认知领域的六个神经心理学评分的加权平均差 (WMD) 和 95% 置信区间 (CI) 用于评估 CPAP 和非 CPAP 干预之间的益处。不同治疗持续时间和依从性的亚组，分为短期（<8周）和长期（≥12周）持续时间，差（夜间<4小时/晚）和良好（夜间≥4小时/晚） ) 依从性也进行了分析。

结果

在 16 项随机对照试验中，包括了 1529 名患有 OSA 的参与者。比较 CPAP 组和对照组的所有治疗持续时间和依从性，观察到反映短期记忆的数字跨度向前的轻微改善 (WMD[95%CI] = 0.67[0.03,1.31]，p = 0.04 ) 。Trail making 测试 B 部分反映了执行功能对于坚持 CPAP 的 OSA 参与者有所改善 (WMD[95%CI] = − 6.24[− 12.60,0.12], p = 0.05 ) 。与对照组相比，接受短期 CPAP 治疗的 OSA 患者 (WMD[95%CI] = − 7.20[− 12.57, − 1.82], p = 0.009) 在执行功能方面有显着改善。长期（≥12周）CPAP治疗组与对照组的所有量表均无统计学差异。