Publikationsserver der Universitätsbibliothek Marburg

Titel:Systematisches Review und Metaanalyse kontrollierter Studien zum nicht erholsamen Schlaf
Autor:Gerhardy, Hanno Julian
Weitere Beteiligte: Sitter, Helmut (Dr.)
Veröffentlicht:2010
URI:https://archiv.ub.uni-marburg.de/diss/z2010/0374
DOI: https://doi.org/10.17192/z2010.0374
URN: urn:nbn:de:hebis:04-z2010-03745
DDC:610 Medizin
Titel (trans.):A systematic review and meta-analysis of the “non restorative sleep” including controlled clinical trials
Publikationsdatum:2010-07-08
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Restless legs syndrome, Metaanalyse, Therapie, OSA, Restless-legs-Syndrom, Systematisches Review, CPAP, Meta-analysis, APAP, CPAP, Treatment, Obstructive sleep apnea, APAP, Systematic review

Zusammenfassung:
Die Konsequenzen des nicht erholsamen Schlafes sind vielfältig und haben bedeutende gesundheitliche und ökonomische Auswirkungen. So verursachen Erkrankungen, wie das obstruktive Schlafapnoesyndrom oder auch das Restless-Legs-Syndrom, neben dem Leiden und den Einschränkungen der einzelnen Individuen auch immense gesellschaftliche Kosten. Es kommt zu signifikanten Folgen wie zunehmenden Krankenhausaufenthalten oder Arztbesuchen, zu Krankschreibungen sowie Frühberentungen, zu erhöhten Unfallraten sowie erhöhter Sterblichkeit. Demzufolge ist eine wirksame Therapie dieser Erkrankungen notwendig. Ziel dieser Arbeit war es, die vorhandene Evidenz zur Therapie von Patienten mit OSA und RLS darzustellen und unter Berücksichtigung der methodischen Qualität der Originalarbeiten die Wirksamkeit der einzelnen Therapieansätze zu ermitteln. Die Verzerrung der Ergebnisse durch mögliche Bias sollten durch weitere Berechnungen untersucht werden. Es wurde eine systematische Literaturrecherche in der Datenbank PubMed mit definierten Ein- und Ausschlusskriterien durchgeführt und die Literaturverzeichnisse der relevanten Studien auf weitere ergänzenden Studien überprüft. Die Qualität aller für die Übersicht relevanten Studien wurde von zwei Begutachtern unabhängig voneinander bewertet. Bei Nichtübereinstimmung der Resultate wurde durch Hinzuziehen eines dritten Experten mittels Konsensusbildung der Evidenzgrad festgelegt. Anschließend wurden nach Überprüfung der Möglichkeit der Durchführung von Metaanalysen mit Hilfe des Review Manager 5 Cochrane (RevMan) Berechnungen für homogene Endpunkte durchgeführt. Es wurden 60 Therapiestudien mit einer Patientenanzahl von 3747 zum Thema Schlafapnoe und 55 Arbeiten zur Behandlung des Restless-Legs-Syndroms mit einer Gesamtzahl von 4171 Patienten identifiziert und bewertet. 48 der Studien, die die Schlafapnoe untersuchten, erreichten den höchsten Evidenzgrand 1b und 28 der Arbeiten, die die RLS-Therapie betrachteten, konnten mit dem Evidenzgrad 1b bewertet werden. Die meisten Studien wurden aufgrund methodischer Schwächen abgewertet. Mängel waren insbesondere das Fehlen einer Kontrollgruppe, nicht eindeutig definierte Ein- und Ausschlusskriterien und/oder eine zu geringe Studienteilnehmerzahl. Im Bereich Schlafapnoe wurden für den Vergleich APAP vs. CPAP Therapie Metaanalysen für acht Endpunkte berechnet. Im Bereich CPAP vs. Placebo/ konservative Therapie wurden Berechnungen für vier Endpunkte durchgeführt. Aufgrund der Metaanalysenberechnungen kann davon ausgegangen werden, dass die APAP-Therapie eine gleichwertige Behandlung zur CPAP-Therapie darstellt. Da durch die APAP-Behandlung keine signifikanten Verbesserungen der Therapieergebnisse im Vergleich zum CPAP gezeigt werden konnten, ist als Therapie der ersten Wahl zur Behandlung der Schlafapnoe die länger erprobte CPAP-Behandlung anzusehen. Für den Vergleich CPAP vs. Placebo/konservative Therapie konnten signifikante Verbesserungen durch die CPAP-Therapie im Vergleich zu den Kontrolltherapien in drei der vier untersuchten Endpunkte gefunden werden (AHI, ESS und MWT). Insbesondere die Endpunkte ESS und MWT, die als Marker der Tagesschläfrigkeit gelten, wurden signifikant durch die CPAP-Therapie im Gegensatz zu den Kontrollen verbessert, so dass die CPAP-Therapie eine effektive Behandlungsart der OSA darstellt. Eine Kontrollberechnung, in der nur Studien mit einem Evidenzgrad von 1b eingeschlossen wurden, zeigte auch für die Studien höchster Qualität eine gute Wirksamkeit der Therapie. Im Bereich RLS war es aufgrund der Inhomogenität der Endpunkte und der unterschiedlichen Therapieansätze nicht möglich, die Ergebnisse in Metaanalysen zu poolen. Die systematische Übersichtsarbeit konnte aber ein gutes Ansprechen der RLS-Symptome auf Dopaminagonisten und Antiepileptika eruieren. Aufgrund der dargestellten Ergebnisse bedarf es weiterer qualitativ hochwertiger Studien, die im Bereich der Schlafapnoe den Nutzen der APAP-Therapie weiter beleuchten und die im Bereich der RLS eine bessere Vergleichbarkeit zulassen.

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