Tratamento farmacológico para apneia central do sono em adultos: revisão sistemática Cochrane
Data
2023-11-30
Autores
Rocha, Aline Pereira da 
Orientadores
Atallah, Álvaro Nagib
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar os benefícios e danos do tratamento farmacológico em comparação com controles ativos ou inativos para a apneia central do sono em adultos. Métodos: Seguimos as recomendações metodológicas conforme os padrões da Cochrane. A última data da busca foi em 30 de agosto de
2022.Incluímos ensaios clínicos randomizados paralelos e cruzados (cross‐over) que avaliaram agentes farmacológico comparado com controles ativos ou controles passivos em adultos com apneia central do sono conforme definido pela 3ª edição da Classificação Internacional dos Distúrbios do Sono. Excluímos estudos que focaram na apneia central do sono devido à respiração periódica em altas altitudes. Os desfechos primários foram índice central de apneia‐hipopneia, mortalidade cardiovascular e eventos adversos graves. Usamos a abordagem GRADE para avaliar a certeza da evidência. Resultados: Incluímos quatro ECRs do tipo cruzado e um ECR paralelo, com um total de 68 participantes (idade média variando de 66 a 71,3 anos, sendo a maioria homens). Os agentes farmacológicos avaliados foram acetazolamida, buspirona, teofilina e triazolam, administrados entre três e uma semana. Um estudo avaliou formalmente eventos adversos leves e raros com a buspirona. Nenhum estudo avaliou qualidade de sono, qualidade de vida, mortalidade ou tempo para intervenção cardiovascular salvar vidas. Quatro estudos recrutaram pessoas com apneia central do sono associadas à insuficiência cardíaca e um estudo incluiu pessoas com apneia central do sono primária. Conclusões: Não há evidências suficientes para apoiar o uso da terapia farmacológica no tratamento da apneia central do sono em adultos. Embora pequenos estudos tenham relatado efeitos positivos de certos agentes para apneia central do sono associada à insuficiência cardíaca na redução do número de eventos respiratórios durante o sono, não pudemos avaliar se esta redução poderia afetar a qualidade de vida dessas pessoas devido ao escasso relato de desfechos clínicos importantes, como a qualidade do sono. Além disso, os estudos tiveram, em sua maioria, um acompanhamento a curto prazo. Há necessidade de estudos de alta qualidade, com
tamanho amostral maior que avaliem os efeitos a longo prazo das intervenções farmacológicas em pacientes com apneia central em adultos.
Objective: To evaluate the benefits and harms of pharmacological treatment compared to active or inactive controls for central sleep apnea in adults. Methods: We followed methodological recommendations according to Cochrane standards. The last search date was on August 30, 2022. We included parallel and crossover randomized clinical trials that evaluated pharmacological agents compared to active or passive controls in adults with central sleep apnea as defined by the 3rd edition of the International Classification of Sleep Disorders. Excluded studies focused on central sleep apnea due to periodic breathing at high altitudes. The primary outcomes were central apnea-hypopnea index, cardiovascular mortality, and serious adverse events. We used the GRADE approach to assess the certainty of evidence. Results: We included four crossover ECRs and one parallel ECR, with a total of 68 participants (mean age ranging from 66 to 71.3 years, mostly men). The evaluated pharmacological agents were acetazolamide, buspirone, theophylline, and triazolam, administered between three and one week. One study formally evaluated mild and rare adverse events with buspirone. No study evaluated sleep quality, quality of life, mortality, or time to life-saving cardiovascular intervention. Four studies recruited people with central sleep apnea associated with heart failure and one study included people with primary central sleep apnea. Conclusions: There is insufficient evidence to support the use of pharmacological therapy in the treatment of central sleep apnea in adults. Although small studies have reported positive effects of certain agents for central sleep apnea associated with heart failure in reducing the number of respiratory events during sleep, we could not evaluate whether this reduction could affect the quality of life of these individuals due to the scarce reporting of important clinical outcomes such as sleep quality. Additionally, the studies had mostly short- term follow-up. There is a need for high-quality studies with larger sample sizes to assess the long-term effects of pharmacological interventions in adult patients with central sleep apnea.
Objective: To evaluate the benefits and harms of pharmacological treatment compared to active or inactive controls for central sleep apnea in adults. Methods: We followed methodological recommendations according to Cochrane standards. The last search date was on August 30, 2022. We included parallel and crossover randomized clinical trials that evaluated pharmacological agents compared to active or passive controls in adults with central sleep apnea as defined by the 3rd edition of the International Classification of Sleep Disorders. Excluded studies focused on central sleep apnea due to periodic breathing at high altitudes. The primary outcomes were central apnea-hypopnea index, cardiovascular mortality, and serious adverse events. We used the GRADE approach to assess the certainty of evidence. Results: We included four crossover ECRs and one parallel ECR, with a total of 68 participants (mean age ranging from 66 to 71.3 years, mostly men). The evaluated pharmacological agents were acetazolamide, buspirone, theophylline, and triazolam, administered between three and one week. One study formally evaluated mild and rare adverse events with buspirone. No study evaluated sleep quality, quality of life, mortality, or time to life-saving cardiovascular intervention. Four studies recruited people with central sleep apnea associated with heart failure and one study included people with primary central sleep apnea. Conclusions: There is insufficient evidence to support the use of pharmacological therapy in the treatment of central sleep apnea in adults. Although small studies have reported positive effects of certain agents for central sleep apnea associated with heart failure in reducing the number of respiratory events during sleep, we could not evaluate whether this reduction could affect the quality of life of these individuals due to the scarce reporting of important clinical outcomes such as sleep quality. Additionally, the studies had mostly short- term follow-up. There is a need for high-quality studies with larger sample sizes to assess the long-term effects of pharmacological interventions in adult patients with central sleep apnea.