The Influence of OSA Treatment on Muscle Sympathetic Nerve Activity: A Systematic Review and Meta‐Analysis
Bibliographic record
Abstract
Introduction Obstructive Sleep Apnea (OSA) is commonly treated with Continuous Positive Airway Pressure (CPAP) therapy, which reduces the number of airway obstructions while sleeping. Recently, diet and exercise interventions have been explored as a possible alternative treatment for OSA. Microneurography is a technique used to measure efferent postganglionic muscle sympathetic nerve activity (MSNA) via direct interneural recordings. CPAP therapy and diet and exercise interventions reduce disease severity, but their influence on MSNA is less clear. Purpose The present meta‐analysis aims to examine the influence of type and length of treatment for OSA on MSNA. Methods A structured search of electronic databases was performed by a research librarian. Two reviewers independently assessed the titles of abstracts of articles; studies meeting eligibility criteria were selected for full‐text review. Two reviewers independently extracted the data and assessed the quality of the studies using Joanna Briggs Institute Critical Appraisal of Evidence Effectiveness tool. Review Manager v5.3 was used to conduct the statistical analyses, and significance was set at P < 0.05. Results Evidence from 10 interventions (n=186) shows CPAP therapy significantly decreases MSNA burst frequency in individuals with OSA (Mean Difference, +12.6 bursts/min; 95% CI, 10.1‐15.2 bursts/min; I 2 = 39%). The same is shown for burst incidence in 6 studies (n=113) (MD, +21.5 bursts/100 hbs; 95% CI, 18.6‐24.5 bursts/100 hbs; I 2 = 0%). Reductions in MSNA (burst frequency and burst incidence) were seen for all time points of CPAP therapy: 1, 6, and 12 months. Data from 5 studies shows a significant decrease in burst frequency following diet and exercise intervention (n=68) (MD, +9.86 bursts/min; 95% CI, 5.37‐14.35 bursts/min; I 2 = 75%). A meta‐regression analysis identified a relationship between CPAP therapy length and burst frequency (R 2 = 0.329, p = 0.003). Conclusion CPAP therapy decreases MSNA in individuals with OSA, and a relationship exists between length of treatment and sympathetic activity. However, a significant reduction in sympathetic activity was also seen as a result of diet and exercise interventions; although, only burst frequency data was reported. More data is needed to determine optimal treatment type and length.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.028 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.035 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".