出版社：Brazilian Association of Sleep and Latin American Federation of Sleep Societies
摘要：Introduction and objective Negative expiratory pressure (NEP) test is used to assess upper airway collapsibility in patients with obstructive sleep apnea (OSA), in which expiratory flow limitation (EFL) has been described as a transient or sustained decrease in expiratory flow during application of NEP. The aim of this systematic review was to describe the NEP test, a new method to assess EFL during spontaneous breathing used to identify patients at risk for OSA. Methods A bibliographic reference research was conducted in the main base of journals indexed data, published between January 1, 1994 (when the technique was started) and March 1, 2015 using NEP technique in subjects with respiratory sleep disorders. This systematic review followed the criteria outlined in the PRISMA statement and the included articles were analyzed according to the evaluation criteria outlined in the second STARD statement. Results About 84 studies published between January 1, 1994 and December 1, 2014 were initially identified. Six articles were excluded because they were written in languages other than English. An additional 21 articles were excluded from the critical analysis for being reviews, descriptive articles, study protocols, case reports,and editorials, for addressing pathologies other than OSA, or for failing to meet the eligibility criteria proposed by the STARD statement. Sixteen studies evaluating the diagnostic accuracy of the NEP technique for OSA were eligible. Conclusion Numerous studies have been conducted in a variety of patient populations and show that NEP is a reliable method for detecting upper airway collapsibility. The NEP test is fast and could serve as a screening test to evaluate with suspected OSA and those with severe OSA as it appears to be a very reliable diurnal test that objectively predicts this respiratory disorder. NEP could be even more powerful in combination with the clinical history data, such as snoring and excessive sleepiness. Further analysis in a more heterogeneous population may also be useful.
