2013美国医师学院成人OSA临床治疗指南

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1、北京大学第一医院呼吸内科马靖Background:TheStandardfirst-lineOSA:CPAPdevicesDentalormandibularadvancementdevices(MADs)Alterativetheraputicstrategies:surgicalinterventionstoremoveobstructiveTissuepositionaltherapypharmacologictreatmentweight-lossinterventionsforobesepatients.Allintervent

2、ionshavethepotentialforadverseeffectsPurpose:presentinformationonboththebenefitsandharmsofinterventionstoassessthenetbenefitsofavailabletreatments.targetaudience:allcliniciansthetargetpatientpopulationcomprisesalladultswithOSAOUTLINEsCPAPforOSATreatmentCPAPVersusControlTr

3、eatmentCPAPVersusShamCPAPOralCPAPVersusNasalCPAPAuto-CPAPVersusFixedCPAPBilevelCPAPVersusFixedCPAPFlexibleBilevelCPAPVersusFixedCPAPC-FlexVersusFixedCPAPCPAPWithorWithoutHumidificationMADsforOSATreatmentMADsVersusNoTreatmentMADsVersusInactiveOralDevicesMADsVersusCPAPOther

4、OSATreatmentStrategiesWeight-LossInterventionsVersusControlTreatmentDrugTherapyVersusControlTreatmentSurgicalInterventionsVersusControlTreatmentSurgicalInterventionsVersusCPAPSurgicalInterventionsVersusMADsAdherencetoCPAPAdherencetoMADTreatmentExtraSupportorEducationTelem

5、onitoringCareBehavioralInterventionsOtherInterventionsCareModelsforPatientsWhoUseCPAPManagementofOSAisbasedon:SymptomstheseverityofthedisorderpatienteducationabouttheriskfactorsandassociatedoutcomesofOSAEvidenceonclinicaloutcomesofOSAinterventionswasverylimited,andmostoft

6、hedatapresentedherefocusonintermediateoutcomes.CPAPModerate-qualityevidenceshowedthatCPAPwasmoreeffectivethancontrolorshamCPAP.Howevernorandomizedtrialsevaluatedthelong-termclinicaloutcomesofCPAPuse,suchasdeathorcardiovascularillnessandevidenceshowingtheeffectofCPAPonqual

7、ityoflifewasinconsistentandthereforeinconclusive.DatatodeterminethecomparativeefficacyofmostCPAPmodificationswereinsufficient;Howevermoderate-qualityevidenceshowedthatfixedandauto-CPAPhaveoverallsimilarefficacyandadherencedespitesmalldifferenceslowqualityevidenceshowedtha

8、tC-FlexandfixedCPAPweresimilarlyefficacious.VariousalternativetherapeuticoptionsMADscouldeffecti