A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea

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.

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

BMJ Open ◽

10.1136/bmjopen-2020-039342 ◽

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.

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215119000240 ◽

2019 ◽

Vol 133 (03) ◽

pp. 168-176 ◽

Cited By ~ 4

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.

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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

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000402 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000402 ◽

Cited By ~ 3

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.

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Obstructive Sleep Apnoea in Patients Treated for Head and Neck Cancer: A Systematic Review of the Literature

Medicina ◽

10.3390/medicina56080399 ◽

2020 ◽

Vol 56 (8) ◽

pp. 399

Author(s):

Massimo Ralli ◽

Flaminia Campo ◽

Diletta Angeletti ◽

Eugenia Allegra ◽

Antonio Minni ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck Cancer ◽

Head And Neck ◽

Obstructive Sleep Apnoea ◽

Neck Cancer ◽

Sleep Apnoea ◽

Partial Laryngectomy ◽

Population Differences ◽

Obstructive Sleep ◽

Meta Analyses

Background and objectives: Obstructive sleep apnoea (OSA) is clinically defined by signs of daytime sleepiness and objective measures of disordered breathing during sleep. The literature is still controversial on the incidence and aetiology of OSA secondary to head and neck cancer treatment. The aim of this systematic review is to evaluate and discuss the prevalence of OSA in patients treated with surgery and/or chemo/radiotherapy for head and neck cancer. Materials and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed on May 2020 using the MEDLINE database, Scopus, and Google Scholar. The searches were conducted using combinations of the following terms: head and neck cancer, OSA, radiotherapy, chemotherapy, partial laryngectomy, laryngeal cancer, neoplasm, tumour, carcinoma, and oropharyngeal cancer. Results: Our results suggest that head and neck cancer patients have a higher incidence of OSA (59.78%) compared to the general population; differences may occur based on the type of treatment. Conclusions: Clinicians should recognise the higher prevalence of OSA in patients treated for head and neck cancer and should consider a comprehensive sleep history as part of the evaluation and management of these patients. Further research is needed to evaluate the exact prevalence, aetiology, and correct management of OSA after treatment for head and neck cancer.

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Obstructive sleep apnoea in a patient with chronic lymphocytic leukaemia

BMJ Case Reports ◽

10.1136/bcr-2018-228763 ◽

2019 ◽

Vol 12 (7) ◽

pp. e228763

Author(s):

Gregory Paul Stimac ◽

Asefa Jejaw Mekonnen

Keyword(s):

Chronic Lymphocytic Leukaemia ◽

Obstructive Sleep Apnoea ◽

Lymphocytic Leukaemia ◽

Oral Appliance ◽

Sleep Apnoea ◽

Caucasian Woman ◽

Upper Airways ◽

Airway Narrowing ◽

Obstructive Sleep ◽

Structural Abnormalities

A 69-year-old Caucasian woman presented with chronic lymphocytic leukaemia (CLL; stage 1-Rai System), significant oropharyngeal lymphoid enlargement, snoring and fatigue. Overnight polysomnography revealed moderately severe obstructive sleep apnoea (OSA), which was managed successfully with oral appliance therapy with resolution of snoring and daytime fatigue. Structural abnormalities of the upper airways are known to cause OSA. Airway narrowing can result from bony structural abnormalities, nasopharyngeal growth, soft tissue redundancy, macroglossia, malignant and benign growth of the upper aero-digestive tract, and adenotonsilar enlargement. Clinicians should be encouraged to consider a diagnosis of OSA in patients with CLL when they present with symptoms of worsening fatigue.

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