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Meta-Analysis
. 2024 Feb 10:79:100330.
doi: 10.1016/j.clinsp.2024.100330. eCollection 2024.

Pharmacological treatment for obstructive sleep apnea: A systematic review and meta-analysis

Maria Luísa Nobre  1 , Ayane Cristine Alves Sarmento  2 , Priscila Farias de Oliveira  3 , Felipe Ferreira Wanderley  4 , José Diniz Júnior  3 , Ana Katherine Gonçalves  5
Affiliations
Meta-Analysis

Pharmacological treatment for obstructive sleep apnea: A systematic review and meta-analysis

Maria Luísa Nobre et al. Clinics (Sao Paulo). .

Abstract

Objective: Summarize the evidence on drug therapies for obstructive sleep apnea.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Embase, Scopus, Web of Science, SciELO, LILACS, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched on February 17th, 2023. A search strategy retrieved randomized clinical trials comparing the Apnea-Hypopnea Index (AHI) in pharmacotherapies. Studies were selected and data was extracted by two authors independently. The risk of bias was assessed using the Cochrane Risk of Bias tool. RevMan 5.4. was used for data synthesis.

Results: 4930 articles were obtained, 68 met inclusion criteria, and 29 studies (involving 11 drugs) were combined in a meta-analysis. Atomoxetine plus oxybutynin vs placebo in AHI mean difference of -7.71 (-10.59, -4.83) [Fixed, 95 % CI, I2 = 50 %, overall effect: Z = 5.25, p < 0.001]. Donepezil vs placebo in AHI mean difference of -8.56 (-15.78, -1.33) [Fixed, 95 % CI, I2 = 21 %, overall effect: Z = 2.32, p = 0.02]. Sodium oxybate vs placebo in AHI mean difference of -5.50 (-9.28, -1.73) [Fixed, 95 % CI, I2 = 32 %, overall effect: Z = 2.86, p = 0.004]. Trazodone vs placebo in AHI mean difference of -12.75 (-21.30, -4.19) [Fixed, 95 % CI, I2 = 0 %, overall effect: Z = 2.92, p = 0.003].

Conclusion: The combination of noradrenergic and antimuscarinic drugs shows promising results. Identifying endotypes may be the key to future drug therapies for obstructive sleep apnea. Moreover, studies with longer follow-up assessing the safety and sustained effects of these treatments are needed.

Prospero registration number: CRD42022362639.

Keywords: Drug therapies; Obstructive Sleep Apneas; Polysomnography; Systematic review.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of the selection process.
Fig. 2
Fig. 2
Forest plots illustrating apnea-hypopnea index mean difference in different drug therapies for obstructive sleep apnea against placebo.
Fig. 3
Fig. 3
Risk of bias of the studies included in the meta-analysis.
Fig. 4
Fig. 4
GRADE strength of the evidence assessment.
See this image and copyright information in PMC

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