Cid-Verdejo Rosana, Chávez Farías Camilo, Martínez-Pozas Oliver, Meléndez Oliva Erika, Cuenca-Zaldívar Juan Nicolás, Ardizone García Ignacio, Martínez Orozco Francisco J, Sánchez Romero Eleuterio A
Faculty of Dentistry, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040, Madrid, Spain; Department of Clinical Dentistry, Faculty of Biomedical Sciences, Universidad Europea de Madrid, Plaza de Francisco Morano s/n, 28670, Madrid, Spain.
Faculty of Dentistry, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040, Madrid, Spain.
Sleep Med Rev. 2024 Apr;74:101906. doi: 10.1016/j.smrv.2024.101906. Epub 2024 Jan 21.
This systematic review and meta-analysis (MA) aimed to evaluate the diagnostic validity of portable electromyography (EMG) diagnostic devices compared to the reference standard method polysomnography (PSG) in assessing sleep bruxism. This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and was registered with PROSPERO prior to the accomplishment of the main search. Ten clinical studies on humans, assessing the diagnostic accuracy of portable instrumental approaches with respect to PSG, were included in the review. Methodological shortcomings were identified by QUADAS-2 quality assessment. The certainty of the evidence analysis was established by different levels of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. A meta-analysis of diagnostic test accuracy was performed with multiple thresholds per study applying a two-stage random effects model, using the thresholds offered by the studies and based on the number of EMG bruxism events per hour presented by the participants. Five studies were included. The MA indicated that portable EMG diagnostic devices showed a very good diagnostic capacity, although a high variability is evident in the studies with some outliers. Very low quality of evidence due to high risk of bias and high heterogeneity among included studies suggests that portable devices have shown high sensitivity and specificity when diagnosing sleep bruxism (SB) compared to polysomnography. The tests performed in the MA found an estimated optimal cut-off point of 7 events/hour of SB with acceptably high sensitivity and specificity for the EMG portable devices.
本系统评价和荟萃分析旨在评估便携式肌电图（EMG）诊断设备与参考标准方法多导睡眠图（PSG）相比，在评估睡眠磨牙症方面的诊断有效性。本系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）声明完成，并在主要检索完成之前在国际前瞻性系统评价注册库（PROSPERO）进行了注册。纳入本评价的有10项关于人类的临床研究，这些研究评估了便携式仪器方法相对于PSG的诊断准确性。通过QUADAS-2质量评估确定了方法学上的缺陷。根据推荐分级、评估、制定和评价（GRADE）框架，通过不同证据水平确定证据分析的确定性。采用两阶段随机效应模型，对每项研究的多个阈值进行诊断试验准确性的荟萃分析，使用研究提供的阈值，并基于参与者每小时的肌电图磨牙症事件数量。纳入了5项研究。荟萃分析表明，便携式肌电图诊断设备显示出非常好的诊断能力，尽管在一些存在异常值的研究中存在明显的高变异性。由于纳入研究中存在高偏倚风险和高异质性，证据质量非常低，这表明与多导睡眠图相比，便携式设备在诊断睡眠磨牙症（SB）时显示出高敏感性和特异性。荟萃分析中进行的测试发现，对于肌电图便携式设备，估计的最佳截断点为每小时7次SB事件，具有可接受的高敏感性和特异性。
