Machado Cláudia Aparecida de Oliveira, de Resende Camila Maria Bastos Machado, Stuginski-Barbosa Juliana, Porporatti André Luís, Carra Maria Clotilde, Michelloti Ambra, Boucher Yves, Simamoto Junior Paulo Cezar
Federal University of Uberlandia, Uberlândia, MG, Brazil.
Instituto de Educação Superior de Brasília, Brasília, DF, Brazil.
J Oral Rehabil. 2024 Oct;51(10):2220-2233. doi: 10.1111/joor.13794. Epub 2024 Jul 15.
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.
The aim of this systematic review and meta-analysis is to assess the association between OSA and TMD in adult population.
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).
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.
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.
阻塞性睡眠呼吸暂停（OSA）在颞下颌关节紊乱病（TMD）患者中非常常见。然而，几乎没有证据表明二者之间存在关联。
本系统评价和荟萃分析旨在评估成年人群中OSA与TMD之间的关联。
在EMBASE、LILACS、LIVIVO、PubMed/MEDLINE、Scopus、Web of Science、Google Scholar、Open Grey和ProQuest数据库中检索关于TMD与OSA关联的病例对照研究、横断面研究和队列研究。TMD应使用研究诊断标准（RDC/TMD）或诊断标准（DC/TMD）进行评估，OSA应使用多导睡眠图（PSG）和/或经过验证的问卷进行评估。使用乔安娜·布里格斯研究所关键评估清单评估偏倚风险；并进行关联荟萃分析。效应量包括二分变量中的比值比（OR）和95%置信区间（CI）。通过使用推荐分级评估、制定和评价（GRADE）对组进行分析来确定证据的确定性。
在筛选的1024篇文章中，7篇符合定性综合的纳入标准，6篇符合定量分析的纳入标准。所有文章的偏倚风险均被分类为低风险。TMD患者中发现与OSA呈正相关（OR = 2.61；95% CI = 2.31，2.95）。无论采用何种OSA诊断方法，也均发现存在显著关联（对于使用PSG + 经过验证问卷的研究：OR = 2.74；95% CI = 2.11，3.57；对于仅使用经过验证问卷的研究：OR = 2.55；95% CI = 2.22，2.92）。GRADE为中等。
无论OSA诊断方法（PSG和/或经过验证的问卷）如何，TMD患者与OSA均存在显著关联。OSA筛查应成为TMD检查常规的一部分。此外，由于所使用的OSA评估方法不同且纳入的研究数量较少，需要纳入更多使用PSG的研究以更好地阐明这种关联。
