多发性硬化症中睡眠呼吸障碍的患病率及临床关联：系统综述与荟萃分析

文献信息

中文摘要

背景： 睡眠呼吸障碍（SDB），包括阻塞性和中枢性睡眠呼吸暂停，可能导致多发性硬化症患者（PwMS）的疲劳、认知障碍和生活质量下降。报告的患病率差异很大，且多发性硬化症特异性因素对SDB风险的影响仍不清楚。
方法： 我们对报告成人多发性硬化症患者SDB客观测量的研究进行了系统综述和荟萃分析。检索数据库截至2025年7月。采用随机效应模型估计合并患病率和平均呼吸暂停低通气指数或呼吸事件指数（AHI/REI）。荟萃回归分析了与人口学和多发性硬化症相关因素的关联。汇总病例对照研究以比较多发性硬化症患者与对照组的SDB比值比。使用GRADE评估证据确定性。
结果： 共纳入29项研究，包括1167例多发性硬化症患者。SDB的合并患病率为30%（95% CI：21-40%），平均AHI为7.2次/小时（95% CI：4.2-10.2），提示以轻度SDB为主。荟萃回归确定较高的体重指数（BMI）、较长的疾病病程、较大的残疾程度（EDSS）以及研究人群中进展型多发性硬化症患者比例较高是AHI升高的预测因素。病例对照研究（n=7）未显示多发性硬化症患者相比对照组SDB比值比显著增加；然而，病例对照研究参与者的EDSS评分相对较低。异质性显著，各结局的证据确定性均极低。
结论： SDB影响相当比例的多发性硬化症患者，尤其是疾病更晚期或BMI较高的患者。尽管大多数检出的SDB为轻度，且多发性硬化症中的疲劳具有多因素起源，但SDB对睡眠质量和认知功能的潜在贡献支持有针对性的筛查方法。进一步研究应评估针对多发性硬化症调整的评估策略是否能改善检测，以及SDB的治疗是否能改善多发性硬化症相关结局。

英文摘要

BACKGROUND: Sleep-disordered breathing (SDB), including obstructive and central sleep apnoea, may contribute to fatigue, cognitive impairment, and reduced quality of life in people with multiple sclerosis (PwMS). Reported prevalence varies widely, and the influence of MS-specific factors on SDB risk remains unclear.
METHODS: We conducted a systematic review and meta-analysis of studies reporting objective measures of SDB in adults with MS. Databases were searched up to July 2025. Pooled prevalence and mean apnoea-hypopnoea or respiratory event index (AHI/REI) were estimated using random-effects models. Meta-regression examined associations with demographic and MS-related factors. Case-control studies were pooled to compare SDB odds in PwMS versus controls. Certainty of evidence was assessed using GRADE.
RESULTS: 29 studies including 1167 PwMS were included. Pooled prevalence of SDB was 30% (95% CI: 21-40%), with a mean AHI of 7.2 events/hour (95% CI: 4.2-10.2), indicating predominantly mild SDB. Meta-regression identified higher body mass index (BMI), longer disease duration, greater disability (EDSS), and a higher proportion of people with progressive MS in the population studied as predictors of elevated AHI. Case-control studies (n = 7) did not show significantly increased odds of SDB in PwMS versus controls; however, case-control participants had relatively low EDSS scores. Heterogeneity was substantial, and certainty of evidence was very low across outcomes.
CONCLUSION: SDB affects a considerable proportion of PwMS, particularly those with more advanced disease or higher BMI. Although most SDB identified was mild and fatigue in MS has multifactorial origins, the potential contribution of SDB to sleep quality and cognitive function supports targeted screening approaches. Further research should evaluate whether MS-adapted assessment strategies improve detection and whether treatment of SDB improves MS-related outcomes.