背景:阻塞性睡眠呼吸暂停(OSA)是颞下颌关节紊乱病(TMD)患者中非常常见的疾病。然而,几乎没有证据表明他们之间有联系。
目的:本系统综述和荟萃分析的目的是评估成人OSA和TMD之间的关联。
方法:病例对照,在EMBASE中搜索了关于TMD和OSA之间关联的横断面和队列研究,LILACS,LIVIVIVO,PubMed/MEDLINE,Scopus,WebofScience,谷歌学者,打开Grey和ProQuest数据库。TMD应使用研究诊断标准(RDC/TMD)或诊断标准(DC/TMD)和OSA使用多导睡眠图(PSG)和/或经过验证的问卷进行评估。使用JoannaBriggs研究所关键评估清单评估偏倚风险;并进行关联荟萃分析。效果测量包括二分变量的比值比(OR)和95%置信区间(CI)。通过使用建议评级评估对小组进行分析来确定证据的确定性,开发和评估(等级)。
结果:在筛选的1024篇文章中,7符合定性综合的纳入标准,和6用于定量分析。所有文章都被归类为低偏倚风险。TMD患者与OSA呈正相关(OR=2.61;95%CI=2.31,2.95)。与所应用的OSA诊断方法无关,也发现了显着关联(对于使用PSG+验证问卷的研究:OR=2.74;95%CI=2.11,3.57;对于仅使用验证问卷的研究:OR=2.55;95%CI=2.22,2.92)。等级适中。
结论:无论采用何种OSA诊断方法(PSG和/或经过验证的问卷),TMD患者均与OSA显著相关。OSA筛查应该是TMD检查常规的一部分。此外,由于所使用的OSA评估方法不同,而且所包括的研究数量较少,有必要纳入更多使用PSG的研究,以更好地阐明这种关联.
BACKGROUND: Obstructive sleep apnea (OSA) is a very common condition in patients with temporomandibular disorders (TMD). However, there is little evidence of a connection between them.
OBJECTIVE: The aim of this systematic review and meta-analysis is to assess the association between OSA and TMD in adult population.
METHODS: Case-control, cross-sectional and cohort studies on the association between TMD and OSA were searched in the EMBASE, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Open Grey and Pro Quest databases. TMD should be assessed using Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) and OSA using polysomnography (PSG) and/or a validated questionnaire. The risk of bias was evaluated using the Joanna Briggs Institute Critical Assessment Checklists; and an association meta-analysis was performed. The effect measure included the odds ratio (OR) in dichotomous variables and a 95% confidence interval (CI). Certainty of evidence was determined by analysing groups using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULTS: Out of the 1024 articles screened, 7 met the inclusion criteria for the qualitative synthesis, and 6 for quantitative analysis. All articles were classified at low risk of bias. A positive association with OSA was found in patients with TMD (OR = 2.61; 95% CI = 2.31, 2.95). A significant association was also found irrespective to the OSA diagnostic methods applied (for studies using PSG + validated questionnaires: OR = 2.74; 95% CI = 2.11, 3.57; for studies using validated questionnaires only: OR = 2.55; 95% CI = 2.22, 2.92). GRADE was moderate.
CONCLUSIONS: Patients with TMD presented a significant association with OSA regardless of the OSA diagnostic method (PSG and/or validated questionnaires). OSA screening should be part of the TMD examination routine. Furthermore, due to the different OSA assessment methods used and the small number of studies included, there is a need to include a larger number of studies using PSG to better elucidate this association.