Meta-analysis of randomized controlled trials of traditional Chinese medicine in the treatment of obstructive sleep apnea syndrome

• Main Author: Jun-Li Bao
• Format: Article
• Language: English
• Published: Editorial Board of Journal of Hainan Medical University 2020-11-01
• Series: Journal of Hainan Medical University
• Subjects: obstructive sleep apnea syndrome (osas）; traditional chinese medicine; randomized controlled trial; meta analysis
• Online Access: http://www.hnykdxxb.com/PDF/202022/07.pdf
• ISSN: 1007-1237; 1007-1237

Objective: Though Chinese medicine (CM) has showed its clinical efficacy for the treatment of obstructive sleep apnea (OSA) in China, no systematic reviews or meta-analyses provide evidences for its therapeutic effects on OSA and the long-term safety. The aim of the present study is to evaluate the effectiveness and safety of CM on OSA using meta-analysis. Methods: We used search items of “Chinese Medicine” AND “obstructive sleep apnea” to retrieve the randomized control trials (RCTs) of CM treatments for OSA in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP database, and Wanfang database from their respective inception dates to December 2019. Only RCTs of CM therapy versus no treatment which could be quantitatively synthesized were included. Finally, 20 studies representing 1,297 participants were included after extraction. Two investigators independently extracted and analyzed the data using RevMan5.3 software. Results: The treatment group using CM decoctions or CM granules presented significantly ameliorative effects on apnoea-hypopnoea index (AHI) compared with the control group (MD: -2.58, 95% CI: -3.59 to -1.56, P < 0.00001 and MD: -5.47, 95% CI: -6.75 to -4.19, P < 0.00001, respectively) in the sensitivity analysis. However, there were non significant differences in the duration of treatment between subgroups, indicating that the duration of treatment has no impacts on the therapeutic effects on AHI. CM granules also showed significantly ameliorative effects on the lowest nocturnal oxygen saturation (LSaO2) (MD: 2.76, 95% CI: 1.85 to 3.68, P < 0.00001). CM decoctions exhibited significantly improved Epworth Sleepiness Scale (ESS) scores compared with the control group in a sensitivity analysis (MD: -1.50, 95% CI: -2.13 to -0.88, P < 0.00001). CM granules showed a better improvement of ESS than the control group (MD: -1.35, 95% CI: -1.92 to -0.78, P < 0.00001). Mild adverse reactions occurred only in five patients and disappeared without special treatment. Conclusion: This study showed favorable therapeutic efficacy of CM on OSA. However, in consideration of the low methodological quality of the included RCTs, more rigorous designed, large sample size RCTs are recommended for providing more high-quality evidences. Journal of Hainan Medical University 2020; 26(22): 32-40 Journal of Hainan Medical University http://www.hnykdxxb.com Corresponding