Objective To evaluate the subjective outcomes of sleepiness behavior and mood status applying continuous positive airway pressure（CPAP） in adults of elderly and middle-aged with obstructive sleep apnea syndrome（OSAS）. Methods Nine randomized controlled trails comparing nocturnal CPAP with inactive control appliances in adults with OSAS with the use of computerized search in related medical databases（MEDLINE，EMBASE，CBMdisk，etc） were included.The quality of literature was reviewed，and all data were extracted by two reviewers independently.Meta analysis was conducted used RevMan 4.2 software.Results 9 RCT involving 665 patients of elderly and middle-aged met the inclusion criteria.Meta analysis indicated that the score of Epworth sleepiness scale（ESS） and general health questionnaire-28（GHQ-28） declined significantly after CPAP treatment on effectiveness with WMD（random） －2.94，95 %CI －4.68 to －1.20，or WMD（fixed） －2.26，95 %CI －3.79 to －0.72，P lt;0.01.Nevertheless，hospital anxiety and depression scale（HADS） was not significantly different between CPAP and control with WMD（random） －0.89，95%CI －1.98 to 0.20，P gt;0.05.Conclusion Current clinical evidence suggested that CPAP was effective in improving day-time subjective outcomes of sleepiness behavior and general mental health status in OSAS patients of elderly and middle-aged，although evidence of improving emotion disorder of anxiety and depression was not confirmed.
Citation：
DONG Huanji,GUO Xuejun,XU Weiguo,LUO Yong,XU Xiaoxin. Meta-analysis of continuous positive airway pressure for obstructive sleep apnea syndrome patients in subjective outcomes of sleepiness behavior and mood status. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(5): 376-382. doi:
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Engleman HM，Martin SE，Deary IJ，et al.Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome.Thorax，1997，52：114-119.
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Engleman HM，Martin SE，Kingshott RN，et al.Randomised placebo controlled trial of daytime function after continuous positive airway pressure（CPAP） therapy for the sleep apnoea/hypopnoea syndrome.Thorax，1998，53：341-345.
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Engleman HM，Kingshott RN，Wraith PK，et al.Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome.Am J Respir Crit Care Med，1999，159：461-467.
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Montserrat JM，Ferrer M，Hernandez L，et al.Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome：a randomized controlled study with an optimized placebo.Am J Respir Crit Care Med，2001，164：608-613.
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Faccenda JF，Boon NA，Mackay TW，et al.CPAP effects on blood pressure in the sleep apnea/hypopnea syndrome（SAHS） during a randomized controlled trial.Am J Respir Crit Care Med，2000，161（Suppl 3）：344-348.
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Barnes M，Houston D，Worsnop CJ，et al.A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea.Am J Respir Crit Care Med，2002，165：773-780.
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Barnes M，McEvoy RD，Banks S，et al.Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea.Am J Respir Crit Care Med，2004，170：656-664.
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Marshall NS，Neill AM，Campbell AJ，et al.Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea.Thorax，2005，60：427-432.
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李延忠，主编.睡眠呼吸障碍性疾病.山东：山东科学技术出版社，2005，148-149.
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但汉雷，白杨，张亚历，等.Meta分析方法及其医学科研价值与评价.中华医学科研管理杂志，2003，16：12-15.
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SIGN（Scottish Intercollegiate Guideline Network）.Management of obstructive sleep apnoea/hypopnoea syndrome in adults（guideline no.73）.www.sign.ac.uk.
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王吉耀，主编.循证医学与临床实践.北京：科学出版社，2002，55-58.
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- 1. Ferini-Strambi L，Fantini ML，Castronovo C.Epidemiology of obstructive sleep apnea syndrome.Minerva Med，2004，95：187-202.
- 2. Sakurai S.Physiopathology and complications of sleep apnea syndrome.Cheyne-Stokes respiration syndrome.Nippon Naika Gakkai Zasshi，2004，93：1109-1113.
- 3. Peng B，Li SW，Kang H，et al.Cognitive and emotional impairment in obstructive sleep apnea syndrome.Chin Med Sci J，2004，19：262-265.
- 4. Johns MW.Daytime sleepiness，snoring，and obstructive sleep apnea.The Epworth Sleepiness Scale.Chest，1993，103：30-36.
- 5. Gugger M，Bassetti C.Effectiveness of nasal CPAP-treatment（continuous positive airway pressure）.Ther Umsch，2000，57：444-448.
- 6. Berwick DM，Budman S，Damico-White J，et al.Assessment of psychological morbidity in primary care：explorations with the General Health Questionnaire.J Chron Dis，1987，40（Suppl 1）：71S-84S.
- 7. Zigmond AS，Snaith RP.The hospital anxiety and depression scale.Acta Psychiatr Scand，1983，67：361-370.
- 8. Jadad AR，Moore RA，Carroll D，et al.Assessing the quality of reports of randomized clinical trials：is blinding necessary? Control Clin Trials，1996，17：1-12.
- 9. Engleman HM，Martin SE，Deary IJ，et al.Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome.Lancet，1994，343：572-575.
- 10. Engleman HM，Martin SE，Deary IJ，et al.Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome.Thorax，1997，52：114-119.
- 11. Engleman HM，Martin SE，Kingshott RN，et al.Randomised placebo controlled trial of daytime function after continuous positive airway pressure（CPAP） therapy for the sleep apnoea/hypopnoea syndrome.Thorax，1998，53：341-345.
- 12. Engleman HM，Kingshott RN，Wraith PK，et al.Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome.Am J Respir Crit Care Med，1999，159：461-467.
- 13. Montserrat JM，Ferrer M，Hernandez L，et al.Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome：a randomized controlled study with an optimized placebo.Am J Respir Crit Care Med，2001，164：608-613.
- 14. Faccenda JF，Boon NA，Mackay TW，et al.CPAP effects on blood pressure in the sleep apnea/hypopnea syndrome（SAHS） during a randomized controlled trial.Am J Respir Crit Care Med，2000，161（Suppl 3）：344-348.
- 15. Barnes M，Houston D，Worsnop CJ，et al.A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea.Am J Respir Crit Care Med，2002，165：773-780.
- 16. Barnes M，McEvoy RD，Banks S，et al.Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea.Am J Respir Crit Care Med，2004，170：656-664.
- 17. Marshall NS，Neill AM，Campbell AJ，et al.Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea.Thorax，2005，60：427-432.
- 18. 李延忠，主编.睡眠呼吸障碍性疾病.山东：山东科学技术出版社，2005，148-149.
- 19. 但汉雷，白杨，张亚历，等.Meta分析方法及其医学科研价值与评价.中华医学科研管理杂志，2003，16：12-15.
- 20. SIGN（Scottish Intercollegiate Guideline Network）.Management of obstructive sleep apnoea/hypopnoea syndrome in adults（guideline no.73）.www.sign.ac.uk.
- 21. 王吉耀，主编.循证医学与临床实践.北京：科学出版社，2002，55-58.
