Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

Abstract

Study Objectives: To assess the methodological quality of published systematic reviews (SRs) and meta-analyses (MAs) about the efficacy of oral appliances (OA) in the management of adult and pediatric sleep-disordered breathing (SDB). Methods: SRs/MAs that evaluated the efficacy of OA therapy on the treatment of SDB in human subjects of all age groups were sought. Multiple electronic databases were searched for articles published in any language from the database's inception until January 2016. Two reviewers independently selected and then assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool. Results: Thirteen reviews on adult SDB were included (2 SRs and 11 SRs with MAs). Of those, seven were medium quality and six were high quality. Only four reviews were included on pediatric SDB (3 SRs and 1 SR with MA). Three of these were of high quality and one was medium quality. The identified limitations in the included reviews were failing to reference the excluded studies or describe reasons for exclusion, lack of applying valid criteria to assess the quality of included studies, lack of publication bias assessment, and absence of conflicts of interest reporting. Conclusions: Overall, SRs/MAs on OA therapy for adult and pediatric SDB were conducted with acceptable methodological quality. High AMSTAR scores should not be extrapolated as a proxy of the methodological quality of the included evidence. There is a need for more primary studies and then that information can be used to be synthesized through SRs on pediatric SDB. Keywords: mandibular advancement device, sleep apnea syndrome, systematic review, treatment efficacy Citation: Al-Jewair TS, Gaffar BO, Flores-Mir C. Quality assessment of systematic reviews on the efficacy of oral appliance therapy for adult and pediatric sleep-disordered breathing. J Clin Sleep Med 2016;12(8):1175-1183. I NTRO DUCTI O NLoud snoring and obstructive sleep apnea (OSA) are common sleep-disordered breathing (SDB) conditions that can affect growing and nongrowing individuals. OSA is characterized by repetitive partial (hypopnea) or complete (apnea) upper airway obstructions lasting at least 10 sec and by snoring during sleep.1 The prevalence in adults ranges from 9% to 24% for OSA and from 2% to 4% for OSA when daytime symptoms are considered.2 SDB/OSA occurs in 1.2% to 5.8% of children and adolescents. 3,4 Multiple factors had been identified in the etiology of SDB/ OSA. These included structural constrictions of the soft tissue space surrounding the oropharynx and nasopharynx and its lumen (i.e., hypertrophied tonsils and/or adenoids), 1 constrictions surrounding the nasal cavity, 5 neuromuscular abnormalities of the upper airway, 1 hyperdivergent craniofacial growth patterns, 6 genetic markers (i.e., tumor necrosis factor-alpha), 7 early life programming 8 (i.e., exposure to secondhand cigarette smoking and poor nutrition), and prenatal factors such as hormonal and physiological changes during gestation, 9 i...

Using the forest plot to compare citation achievements in bibliographic and meta-analysis studies since 2011 using data on PubMed Central: A retrospective study

“…[21,30,31] In view of the fact that SRs and MAs studies may influence and guide clinical practice, [32] many have analyzed the quality of SRs and MAs in the literature. [32][33][34] Of 126 articles in the study, [32] 35 reviews (28%) were regarded as "poor" in terms of methodological quality, 59 (47%) as "fair," and 32 (25%) as "good. "…”

Efficacy of a mandibular advancement intraoral appliance (MOA) for the treatment of obstructive sleep apnea syndrome (OSAS) in pediatric patients: A pilot-study

“…This success has already been demonstrated in adults by promoting: the reduction in the daytime sleepiness and in the obstructive episodes during sleep, the improvement in the oxygen saturation, the reduction in snoring intensity and frequency, and the improvement in sleep quality ( 24 ). In patients with skeletal/occlusal alterations undergoing orthodontic treatment, improvement in AHI and facial profile has also been demonstrated ( 25 - 29 ). The MOA made here from translucent thermoplastic soft bite splints were flexible, unexpensive, comfortable, easily adaptable, and used by all subjects; they had no interference with dental/skeletal growth within the time period (i.e., 60 days) assessed.…”

“…The MOA made here from translucent thermoplastic soft bite splints were flexible, unexpensive, comfortable, easily adaptable, and used by all subjects; they had no interference with dental/skeletal growth within the time period (i.e., 60 days) assessed. However, long-term longitudinal studies should be performed, due to possible irreversible changes in the dentition and TMJs ( 29 ). The durability of these soft appliances is also limited, so it is a temporary solution ( 8 , 19 , 20 ).…”

Review of systematic reviews on mandibular advancement oral appliance for obstructive sleep apnea: The importance of long-term follow-up

“…Descriptions of the included SRs are shown in Table 1. In 2016, Al-Jewair et al [30] examined the methodological quality of the SRs and the meta-analyses (MA) on OA therapy. They concluded that the SRs on OA therapy for adult and pediatric sleep-disordered breathing were conducted with an overall acceptable methodological quality.…”