TY - JOUR
T1 - Models of anatomically based oropharyngeal rehabilitation with a multilevel approach for patients with obstructive sleep apnea
T2 - a meta-synthesis and meta-analysis
AU - Lin, Hsin Yu
AU - Su, Po Lan
AU - Lin, Cheng Yu
AU - Hung, Ching Hsia
N1 - Funding Information:
The authors are grateful to Dr. Chung-Yi. Li (Department of Public Health, National Cheng Gung University, Taiwan) for providing consultation of systemic review and meta-analysis. The database is supported by Ching-Ju Fang (Medical Library, National Cheng Kung University, Taiwan). The authors would like also to thank Dr. Meiho Nagayama (Department of Otolaryngology, Nagoya City University Hospital, Japan) and Dr. Tieh-Cheng Fu (Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taiwan) for advice with this manuscript.
Funding Information:
The authors are grateful to Dr. Chung-Yi. Li (Department of Public Health, National Cheng Gung University, Taiwan) for providing consultation of systemic review and meta-analysis. The database is supported by Ching-Ju Fang (Medical Library, National Cheng Kung University, Taiwan). The authors would like also to thank Dr. Meiho Nagayama (Department of Otolaryngology, Nagoya City University Hospital, Japan) and Dr. Tieh-Cheng Fu (Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taiwan) for advice with this manuscript. AHI apnea hypopnea index, BMI body mass index, ESS Epworth sleepiness scale, LSAT lowest oxygen saturation, NC neck circumference, OPR oropharyngeal rehabilitation, OSA obstructive sleep apnea, TMJ temporomandibular joint
Publisher Copyright:
© 2019, Springer Nature Switzerland AG.
PY - 2020/12
Y1 - 2020/12
N2 - Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder associated with dysfunction of oropharyngeal muscles to maintain upper airway patency during sleep. Oropharyngeal rehabilitation (OPR) was developed to restore, reconstruct, and reeducate oropharyngeal muscle function, but current protocols and effectiveness of OPR have been inconsistent. The purpose of this study was to review (1) indications of OPR, (2) protocols of OPR, and (3) effectiveness of OPR. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library and then conducted both meta-synthesis and meta-analysis according to the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results: A total of eight studies with 203 patients were included. By means of meta-synthesis, the patients with middle age, BMI < 40 kg/m2, mild-to-moderate OSA, and non-severe upper airway anatomical abnormality were found to benefit from OPR. The protocol of OPR was summarized to be an anatomically based, multilevel approach, including the retropalatal, retroglossal, hypopharyngeal, TMJ, and facial levels. By using meta-analysis, overall outcomes were presented as apnea hypopnea index (AHI) with significant improvement from 25.2 ± 7.8/h to 16.1 ± 6.6/h (mean difference [MD] – 9.8 [95% CI − 11.0 to − 8.6], p < 0.0001); the lowest oxygen saturation (LSAT) improved from 80.2 ± 4.7 to 83.8 ± 2.9% (MD 3.0% [95% CI 2.0 to 4.0], p < 0.0001); Epworth sleepiness scale (ESS) improved from 11.8 ± 1.9 to 6.3 ± 1.6 (MD − 5.9 [95% CI − 7.5 to − 4.2], p < 0.001), neck circumference (NC) from 35.2 ± 1.1 to 34.7 ± 0.9 cm (MD − 0.6 [95% CI − 0.9 to − 0.2], p = 0.002), BMI from 24.8 ± 3.7 to 24.8 ± 4.1 kg/m2 (MD − 0.0; 95% CI − 0.5 to 0.5, p = 0.95). All outcomes except BMI demonstrated significant improvement from OPR. Conclusions: Meta-analysis of previous OPR reports shows an improvement in AHI of 39%, compared with the usual surgical definition of success at 50%. Only mild and moderate cases of OSA were referred for OPR in the prior studies. In order to improve outcomes with OPR, a comprehensive approach to rehabilitation should be emphasized.
AB - Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder associated with dysfunction of oropharyngeal muscles to maintain upper airway patency during sleep. Oropharyngeal rehabilitation (OPR) was developed to restore, reconstruct, and reeducate oropharyngeal muscle function, but current protocols and effectiveness of OPR have been inconsistent. The purpose of this study was to review (1) indications of OPR, (2) protocols of OPR, and (3) effectiveness of OPR. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library and then conducted both meta-synthesis and meta-analysis according to the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results: A total of eight studies with 203 patients were included. By means of meta-synthesis, the patients with middle age, BMI < 40 kg/m2, mild-to-moderate OSA, and non-severe upper airway anatomical abnormality were found to benefit from OPR. The protocol of OPR was summarized to be an anatomically based, multilevel approach, including the retropalatal, retroglossal, hypopharyngeal, TMJ, and facial levels. By using meta-analysis, overall outcomes were presented as apnea hypopnea index (AHI) with significant improvement from 25.2 ± 7.8/h to 16.1 ± 6.6/h (mean difference [MD] – 9.8 [95% CI − 11.0 to − 8.6], p < 0.0001); the lowest oxygen saturation (LSAT) improved from 80.2 ± 4.7 to 83.8 ± 2.9% (MD 3.0% [95% CI 2.0 to 4.0], p < 0.0001); Epworth sleepiness scale (ESS) improved from 11.8 ± 1.9 to 6.3 ± 1.6 (MD − 5.9 [95% CI − 7.5 to − 4.2], p < 0.001), neck circumference (NC) from 35.2 ± 1.1 to 34.7 ± 0.9 cm (MD − 0.6 [95% CI − 0.9 to − 0.2], p = 0.002), BMI from 24.8 ± 3.7 to 24.8 ± 4.1 kg/m2 (MD − 0.0; 95% CI − 0.5 to 0.5, p = 0.95). All outcomes except BMI demonstrated significant improvement from OPR. Conclusions: Meta-analysis of previous OPR reports shows an improvement in AHI of 39%, compared with the usual surgical definition of success at 50%. Only mild and moderate cases of OSA were referred for OPR in the prior studies. In order to improve outcomes with OPR, a comprehensive approach to rehabilitation should be emphasized.
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U2 - 10.1007/s11325-019-01971-8
DO - 10.1007/s11325-019-01971-8
M3 - Review article
C2 - 31836993
AN - SCOPUS:85076858855
SN - 1520-9512
VL - 24
SP - 1279
EP - 1291
JO - Sleep and Breathing
JF - Sleep and Breathing
IS - 4
ER -