Upper airway volumetric changes of obstructive sleep apnoea patients treated with oral appliances: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Vasileios K Dontsos ◽  
Athina Chatzigianni ◽  
Moschos A Papadopoulos ◽  
Evangelia Nena ◽  
Paschalis Steiropoulos
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Cochrane Library ◽  
Apnea Hypopnea Index ◽  
Oral Appliances ◽  
Volume Increase ◽  
Obstructive Sleep

Summary Background Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial upper airway obstruction. Among different treatment options for OSA, Continuous Positive Airway Pressure, and oral appliances (OAs) have been used, with various outcomes and side effects. Objective The aim of this study was to summarize current knowledge in an evidence-based manner regarding the upper airway volume increase of OSA patients while treated with OAs. Search methods Electronic search was conducted in Pubmed, Cochrane Library, and Scopus, up to May 2020. Selection criteria Studies were selected after the application of predetermined eligibility criteria. Data collection and analysis Mean airway volume differences and the corresponding 95% confidence intervals were calculated, using the random effects model. Sensitivity, exploratory, and meta-regression analyses were also implemented. Results Eleven studies filled the inclusion criteria and were included in the systematic review, while 10 of them were suitable for meta-analysis. In total, 291 patients were included, with mean upper airway volume increase of 1.95 cm3 (95% CI, 1.37–2.53; P < 0.001) with Mandibular Advancement Devices in place. In all studies, post-treatment Apnea Hypopnea Index (AHI) was either <10 events/hour or was reduced by more than 50% from baseline levels. A greater increase of the velopharynx volume was observed, regarding airway compartments. Conclusions Treatment with OAs in OSA may lead to a significant increase of the upper airway volume with a subsequent decrease of AHI. The velopharynx seems to be affected the most from OA therapy.

Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis

2019 ◽  
Vol 133 (03) ◽  
pp. 168-176 ◽  
Author(s):  
S Sharma ◽  
J C R Wormald ◽  
J M Fishman ◽  
P Andrews ◽  
B T Kotecha
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Current Evidence ◽  
Nasal Surgery ◽  
Surgical Interventions ◽  
Obstructive Sleep

AbstractObjectivesObstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.MethodsA systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.ResultsSixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.ConclusionNasal surgery may have limited benefit for a subset of patients based on current evidence.

scholarly journals Weight loss surgery for obstructive sleep apnoea with obesity in adults: a systematic review and meta-analysis protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e020876 ◽  
Author(s):  
Zhiyong Dong ◽  
Brian Y Hong ◽  
Ashley M Yu ◽  
John Cathey ◽  
Sheikh Mohammed Shariful Islam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Obstructive Sleep Apnoea ◽  
Weight Loss Surgery ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Controlled Trials ◽  
Obstructive Sleep

IntroductionObstructive sleep apnoea (OSA) is caused by complete or partial obstruction of the upper airway resulting in repeated episodes of interrupted or shallow breaths. OSA is associated with significant morbidity and mortality. The prevalence is estimated to range from 3% to 7% in the general population but may be much higher. Several studies show that weight loss or bariatric surgery may have a role in treating OSA. The aim of this systematic review is to assess the safety and efficacy of randomised controlled trials (RCTs) of weight loss surgery for adults with OSA and comorbid obesity.Methods and analysisA search of the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and two major Chinese biomedical databases will be performed to identify related trials published as of October 2018. This study will include RCTs, comparing different types of weight loss surgery for OSA with obesity or weight loss surgery for OSA with obesity with other upper airway surgeries. The primary outcomes that will be measured are apnoea–hypopnoea index, excess weight loss and in-hospital mortality. The secondary outcomes will include duration of hospital stay, neck circumference, reoperation, waist circumference, body mass index, Epworth Sleepiness Scale score, overt complications (eg, gastric fistula, bleeding, delayed gastric emptying, wound infection), quality of life, quality of sleep and/or functionality. The systematic review will be conducted according to the recommendations as outlined by the Cochrane collaboration.Ethics and disseminationThe systematic review and meta-analysis will include published data available online and thus ethics approval will not be required. The findings will be disseminated and published in a peer-reviewed journal. Review updates will be conducted if there is new evidence that may cause any change in review conclusions. Any changes to the study protocol will be updated in the PROSPERO trial registry accordingly.PROSPERO registration numberCRD42017081743.

scholarly journals Clinical Evidence in the Treatment of Obstructive Sleep Apnoea with Oral Appliances: A Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Andrea Rossi ◽  
Antonino Lo Giudice ◽  
Camilla Di Pardo ◽  
Alberto Teodoro Valentini ◽  
Francesca Marradi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Assessment Tool ◽  
Sleep Apnoea ◽  
Common Finding ◽  
Control Group ◽  
Oral Appliances ◽  
Inclusion Criteria ◽  
Obstructive Sleep ◽  
Definition Of

Background. Recent clinical guidelines have extended indications for oral appliances to subjects affected by moderate-to-severe obstructive sleep apnoea (OSA). The aim of this systematic review covering this important issue for public health is twofold: updating and summarizing the best available scientific evidence by selecting RCTs of quality only, and identifying the therapeutic pathways that can be transferred to the current clinical practice. Methods. All the abstracts which were published before February 18, 2019, have been identified in three electronic databases (PubMed, Web of Science, and Cochrane). The Cochrane Collaboration’s tool for assessing risk of bias was used as an assessment tool in order to evaluate the quality of the selected studies. Results. The search strategy yielded 2,260 studies. After removing duplicates and studies that did not comply with the inclusion criteria, 32 full-text articles were assessed for eligibility, and 17 RCTs were finally included in the qualitative synthesis. The 17 selected studies were very heterogeneous in the type of included RCTs in terms of patient inclusion criteria, sample size, distribution of the two genders in the various groups, duration of treatment, and definition of primary and secondary outcomes, without any restriction on the definition of the control group. A common finding was the positive responsiveness of oral appliance treatment in subjects affected by mild-to-moderate OSA with some evidence for cases of severe OSA. Conclusion. Higher-quality studies are needed in order to provide additional useful guidelines for dental clinicians for OSA management.

scholarly journals Does obstructive sleep apnoea contribute to obesity, hypertension and kidney dysfunction in children? A systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039342
Author(s):  
Sara Rodriguez-Lopez ◽  
Stefan Palkowski ◽  
Christopher Gerdung ◽  
Diana Keto-Lambert ◽  
Meghan Sebastianski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Kidney Function ◽  
Obstructive Sleep Apnoea ◽  
Systemic Blood Pressure ◽  
Sleep Apnoea ◽  
Cochrane Library ◽  
Systemic Blood ◽  
Obstructive Sleep ◽  
Obesity Hypertension

IntroductionChildhood obstructive sleep apnoea (OSA) is a highly prevalent disorder that may directly contribute to the development of obesity, hypertension and renal injury. Although those associations seem to be clearer in adults, studies in children have revealed conflicting results and updated synthesis of the evidence is lacking. The aim of this systematic review is to summarise the available evidence on the effect of OSA on obesity, systemic blood pressure and kidney function, to help to elucidate whether respiratory interventions to correct OSA would have the potential to improve those outcomes.Methods and analysisA systematic literature review search was created by a medical librarian and peer-reviewed by a second librarian prior to running. Ovid Medline, Ovid Embase, CINAHL via EbscoHOST, Wiley Cochrane Library and ProQuest Dissertations and Theses Global were searched on 25 February 2020. Titles and abstracts will be screened by two independent reviewers for inclusion, followed by full-text screening of relevant articles. Studies in children will be included if they report data on OSA and weight, systemic blood pressure or kidney parameters. The extracted data will be combined for analysis and the information subcategorised in groups based on outcome. Risk of bias will be determined using tools specific to study methodology and certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.Ethics and disseminationThis study will provide essential information for healthcare professionals to better understand the relationship between childhood OSA and changes in body mass index, systemic blood pressure and kidney function indicators. Our findings will be disseminated through conferences and publications. The results of this review may guide the initiation of new strategies and the development of future research studies. This research did not involve human subjects and therefore did not undergo research ethical review.PROSPERO registration numberCRD42020171186.

scholarly journals Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea–hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis

2019 ◽  
Vol 6 (1) ◽  
pp. e000402 ◽  
Author(s):  
Maria Giralt-Hernando ◽  
Adaia Valls-Ontañón ◽  
Raquel Guijarro-Martínez ◽  
Jorge Masià-Gridilla ◽  
Federico Hernández-Alfaro
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Eligibility Criteria ◽  
Pharyngeal Airway ◽  
Maxillomandibular Advancement ◽  
Subsequent Decrease ◽  
Obstructive Sleep

BackgroundA systematic review was carried out on the effect of surgical maxillomandibular advancement (MMA) on pharyngeal airway (PA) dimensions and the apnoea–hypopnoea index (AHI) in the treatment of obstructive sleep apnoea (OSA), with the aim of determining whether increased PA in the context of MMA is the main factor conditioning the subsequent decrease in AHI.MethodsA search was made of the PubMed, Embase, Google Scholar and Cochrane databases. A total of 496 studies were identified. The inclusion criteria were a diagnosis of moderate to severe OSA, MMA success evaluated by polysomnography, reporting of the magnitude of MMA achieved, PA increase and a minimum follow-up of 6 months.ResultsFollowing application of the eligibility criteria, eight articles were included. Metaregression analysis showed MMA to significantly increase both pharyngeal airway volume (PAV) (mean 7.35 cm3 (range 5.35–9.34)) and pharyngeal airway space (mean 4.75 mm (range 3.15–6.35)) and ensure a final AHI score below the threshold of 20 (mean 12.9 events/hour).ConclusionsAlthough subgroup analysis showed MMA to be effective in treating OSA, more randomised trials are needed to individualise the required magnitude and direction of surgical movements in each patient, and to standardise the measurements of linear and nonlinear PAV parameters.

Management of paediatric obstructive sleep apnoea: A systematic review and network meta‐analysis

2019 ◽  
Vol 30 (2) ◽  
pp. 156-170 ◽  
Author(s):  
Shih‐Ying Lin ◽  
Yu‐Xuan Su ◽  
Yi‐Cheng Wu ◽  
Jenny Zwei‐Chieng Chang ◽  
Yu‐Kang Tu
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep

scholarly journals Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta-analysis

2015 ◽  
Vol 33 (2) ◽  
pp. 158-168 ◽  
Author(s):  
W. B. Leong ◽  
F. Jadhakhan ◽  
S. Taheri ◽  
Y. F. Chen ◽  
P. Adab ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diabetic Retinopathy ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep
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