Ventilação não invasiva com pressão positiva para tratamento de disfunção erétil em homens com apneia obstrutiva do sono: revisão sistemática Cochrane
Data
2023-11-08
Autores
Barbosa, Frederico Teixeira 
Orientadores
Riera, Rachel
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A síndrome da apneia obstrutiva do sono (SAOS) está associada a várias doenças crônicas, incluindo a disfunção erétil (DE). O tratamento da SAOS com terapia de pressão positiva não-invasiva nas vias aéreas está associado à melhoria dos sintomas respiratórios, e pode contribuir para a melhoria das condições associadas, como a DE. Objetivo: Avaliar a efetividade e aceitabilidade da terapia de pressão positiva não invasiva das vias aéreas para melhorar a DE na SAOS. Métodos: Foram considerados ensaios clínicos randomizados (ECR) comparando qualquer terapia de pressão positiva não invasiva nas vias aéreas (como pressão positiva contínua nas vias aéreas (CPAP), pressão positiva nas vias aéreas bilevel (BiPAP), pressão positiva variável nas vias aéreas (VPAP), ou dispositivos similares) versus sham, nenhum tratamento, lista de espera, ou tratamento farmacológico para DE. Foi realizada busca eletrônica em oito bases de dados eletrônicas, duas plataformas de registro de ensaios clínicos, busca manual em lista de referências, sem restrição quanto à data, idioma ou tipo de publicação. Os desfechos primários considerados foram: taxa de remissão da DE e eventos adversos graves. Os desfechos secundários foram qualidade de vida sexual, qualidade de vida relacionada com a saúde e eventos adversos menores. Como medidas resumo das estimativas de tamanho do efeito, foi calculado o risco relativo (RR) para os dados dicotômicos e a diferença de média (DM) para os dados contínuos, com intervalo de confiança de 95% (IC 95%). A certeza da evidência foi avaliada segundo o Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: Foram incluídos seis ECR (total de 315 participantes). Todos os estudos apresentavam algum risco importante de viés relacionado com a seleção, mascaramento de equipe e participantes ou relato seletivo de desfechos. Os ECR avaliaram três comparações. Para a comparação CPAP versus nenhuma intervenção, há incerteza sobre o efeito do CPAP na pontuação média de DE após 4 semanas, usando o índice internacional de função erétil (IIEF-5) (DM 7,50, IC 95% 4,05 a 10,95; certeza de evidência muito baixa) e após 12 semanas usando o índice internacional de função erétil - domínio ereção (IIEF-ED) (DM 2,50, IC 95% -1,10 a 6,10; certeza da evidência muito baixa); há incerteza sobre o efeito do CPAP na qualidade de vida relacionada ao sexo após 12 semanas, usando o teste de autoestima e relacionamento (SEAR) (DM 1,00, IC 95% -8,09 a 10,09; certeza de evidência muito baixa); nenhum evento adverso grave foi relatado após 4 semanas (certeza de evidência muito baixa). Para a comparação CPAP versus sham, um ECR avaliou esta comparação, mas não foi possível extrair os resultados devido ao desenho e a forma de relato. Para a comparação CPAP versus sildenafil, o sildenafil pode ser melhor do que o CPAP na função erétil com 12 semanas, medido com o IIEF-ED (DM -4,78, IC 95% -6,98 a -2,58; I2 = 59%; certeza de evidência baixa); há incerteza sobre o efeito do CPAP sobre a qualidade de vida relacionada ao sexo após 12 semanas, medida com o Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) (DM -1,24, IC 95% -1,80 a -0,67; I2 = 0%; certeza de evidência muito baixa); não foram relatados eventos adversos graves para nenhum dos grupos (certeza de evidência muito baixa); há incerteza sobre os efeitos do CPAP na incidência de eventos adversos menores (RR 1,33, IC 95% 0,34 a 5,21; certeza de evidência muito baixa). Conclusões: Considerando os dados disponíveis, as evidências são incertas sobre a efetividade e a aceitabilidade do CPAP e outras terapias não invasivas de pressão positiva nas vias aéreas para melhorar a DE em homens com SAOS.
Introduction: Obstructive sleep apnoea syndrome (OSAS) is associated with several chronic diseases, including erectile dysfunction (ED). The treatment of OSAS with non-invasive positive airway pressure therapy is associated with improvement of respiratory symptoms, and may contribute to the improvement of associated conditions, such as ED. Objective: To assess the effectiveness and acceptability of non-invasive positive airway pressure therapy for improving erectile dysfunction in OSAS. Methods: Were considered randomized controlled trials (RCT) comparing any non-invasive positive airway pressure therapy (such as continuous positive airways pressure (CPAP), bilevel positive airway pressure (BiPAP), variable positive airway pressure (VPAP), or similar devices) versus sham, no treatment, waiting list, or pharmacological treatment for ED. An electronic search was performed in eight electronic databases, two clinical trial registration platforms, and a manual search of the reference list, with no restriction as to date, language or type of publication. The primary outcomes considered were ED remission rate and serious adverse events. Secondary outcomes were sex-related quality of life, health-related quality of life, and minor adverse events. As summary measures of effect size estimates, the relative risk (RR) was calculated for dichotomous data and the mean difference (MD) for continuous data, with 95% confidence interval (95% CI). The certainty of the evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Six RCTs were included (total 315 participants). All studies had some important risk of bias related to selection, performance, assessment, or reporting bias. The RCTs evaluated three comparisons. For the CPAP versus no CPAP comparison, there is uncertainty about the effect of CPAP on the mean ED score after 4 weeks using the International Index of Erectile Function (IIEF-5) (MD 7.50, 95% CI 4.05 to 10.95; very low-certainty evidence) and after 12 weeks using the International Index of Erectile Function - Erection Domain (IIEF-ED) (MD 2.50, 95% CI -1.10 to 6.10; very low-certainty evidence); there is uncertainty about the effect of CPAP on sex-related quality of life after 12 weeks using the self-esteem and relationship test (SEAR) (MD 1.00, 95% CI -8.09 to 10.09; very low-certainty evidence); no serious adverse events were reported after 4 weeks (very low-certainty evidence). For the CPAP versus sham comparison, one RCT evaluated this comparison. but it was not possible to extract the results due to the design and reporting form. For the CPAP versus sildenafil comparison, sildenafil may be superior for erectile function at 12 weeks, measured with the IIEF-ED (MD -4.78, 95% CI -6.98 to -2.58; I2 = 59%; low-certainty evidence); there is uncertainty about the effect of CPAP on sex-related quality of life after 12 weeks, measured with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) (MD -1.24, 95% CI -1.80 to -0.67; I2 = 0%; very low-certainty evidence), no serious adverse events were reported for either group (certainty very low evidence), and there is uncertainty about the effects of CPAP on the incidence of minor adverse events (RR 1.33, 95% CI 0.34 to 5.21; very low-certainty evidence). Conclusions: Considering the available data, the evidence is uncertain about the effectiveness and acceptability of CPAP and other non-invasive positive airway pressure therapies for improving erectile dysfunction in men with obstructive sleep apnea.
Introduction: Obstructive sleep apnoea syndrome (OSAS) is associated with several chronic diseases, including erectile dysfunction (ED). The treatment of OSAS with non-invasive positive airway pressure therapy is associated with improvement of respiratory symptoms, and may contribute to the improvement of associated conditions, such as ED. Objective: To assess the effectiveness and acceptability of non-invasive positive airway pressure therapy for improving erectile dysfunction in OSAS. Methods: Were considered randomized controlled trials (RCT) comparing any non-invasive positive airway pressure therapy (such as continuous positive airways pressure (CPAP), bilevel positive airway pressure (BiPAP), variable positive airway pressure (VPAP), or similar devices) versus sham, no treatment, waiting list, or pharmacological treatment for ED. An electronic search was performed in eight electronic databases, two clinical trial registration platforms, and a manual search of the reference list, with no restriction as to date, language or type of publication. The primary outcomes considered were ED remission rate and serious adverse events. Secondary outcomes were sex-related quality of life, health-related quality of life, and minor adverse events. As summary measures of effect size estimates, the relative risk (RR) was calculated for dichotomous data and the mean difference (MD) for continuous data, with 95% confidence interval (95% CI). The certainty of the evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Six RCTs were included (total 315 participants). All studies had some important risk of bias related to selection, performance, assessment, or reporting bias. The RCTs evaluated three comparisons. For the CPAP versus no CPAP comparison, there is uncertainty about the effect of CPAP on the mean ED score after 4 weeks using the International Index of Erectile Function (IIEF-5) (MD 7.50, 95% CI 4.05 to 10.95; very low-certainty evidence) and after 12 weeks using the International Index of Erectile Function - Erection Domain (IIEF-ED) (MD 2.50, 95% CI -1.10 to 6.10; very low-certainty evidence); there is uncertainty about the effect of CPAP on sex-related quality of life after 12 weeks using the self-esteem and relationship test (SEAR) (MD 1.00, 95% CI -8.09 to 10.09; very low-certainty evidence); no serious adverse events were reported after 4 weeks (very low-certainty evidence). For the CPAP versus sham comparison, one RCT evaluated this comparison. but it was not possible to extract the results due to the design and reporting form. For the CPAP versus sildenafil comparison, sildenafil may be superior for erectile function at 12 weeks, measured with the IIEF-ED (MD -4.78, 95% CI -6.98 to -2.58; I2 = 59%; low-certainty evidence); there is uncertainty about the effect of CPAP on sex-related quality of life after 12 weeks, measured with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) (MD -1.24, 95% CI -1.80 to -0.67; I2 = 0%; very low-certainty evidence), no serious adverse events were reported for either group (certainty very low evidence), and there is uncertainty about the effects of CPAP on the incidence of minor adverse events (RR 1.33, 95% CI 0.34 to 5.21; very low-certainty evidence). Conclusions: Considering the available data, the evidence is uncertain about the effectiveness and acceptability of CPAP and other non-invasive positive airway pressure therapies for improving erectile dysfunction in men with obstructive sleep apnea.