肌功能疗法治疗阻塞性睡眠呼吸暂停的疗效：系统综述和网络荟萃分析

IF 4.1 4区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Evidence-Based Dental Practice Pub Date : 2025-03-09 DOI:10.1016/j.jebdp.2025.102137

Ying Xu Ph.D , Ruicong Yang MSc , Min Yu M.D. , Xuemei Gao M.D., Ph.D.

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引用次数: 0

摘要

目的肌功能疗法（MT）已成为阻塞性睡眠呼吸暂停（OSA）的辅助治疗方法。本系统综述和随机对照试验（RCTs）网络荟萃分析旨在评估MT治疗成人和儿童OSA的疗效。方法检索至2024年4月30日的4个电子数据库。采用多变量随机效应进行meta分析、亚组分析和网络meta分析来估计汇总差异，重点关注客观和主观指标。结果共纳入15项rct，涉及473名成人和139名儿童，其中10项成人研究（n = 380）纳入网络meta分析。与对照组相比，MT改善了Epworth嗜睡量表(ESS) - 3.54 （95%CI - 5.96至- 1.13,P = .004）和匹兹堡睡眠质量指数(PSQI) - 2.24 (95%CI - 3.46至- 1.01,P = .0003)，但呼吸暂停低通气指数（AHI）无统计学意义变化（- 8.73/h, 95%CI - 21.19至3.74/h, P = . 0.17）。成人的觉醒指数和打鼾强度也有所改善。MT联合持续气道正压通气（CPAP）可显著降低AHI，但并未显著提高CPAP的疗效。有限的证据表明，MT可能有利于儿童OSA患者的AHI和平均SpO2，高度的依从性是必不可少的。网络荟萃分析支持MT作为改善成人主观指标的有希望的辅助手段，并表明当每日训练超过30分钟时，MT可以显着改善AHI。此外，MTSP和MT联合肌筋膜松解可能对主观结果有进一步的好处。

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Efficacy of myofunctional therapy for obstructive sleep apnea: A systematic review and network meta-analysis

Objectives

Myofunctional therapy (MT) has emerged as an adjunct treatment for obstructive sleep apnea (OSA). This systematic review and network meta-analysis of randomized controlled trials (RCTs) aims to evaluate the efficacy of MT in treating adult and pediatric OSA.

Methods

Four electronic databases were searched until April 30, 2024. Meta-analysis, subgroup, and network meta-analysis using multivariate random effects were performed to estimate pooled differences, focusing on objective and subjective indicators.

Results

A total of 15 RCTs involving 473 adults and 139 children were eligible, with 10 adult studies (n = 380) included in the network meta-analysis. Compared to the controls, MT yielded an improved decrease in Epworth sleepiness scale (ESS) of −3.54 (95%CI −5.96 to −1.13, P = .004) and Pittsburgh sleep quality index (PSQI) of −2.24 (95%CI −3.46 to −1.01, P = .0003), though no statistically significant change in apnea-hypopnea index (AHI) (−8.73/h, 95%CI −21.19 to 3.74/h, P = 0.17). Improvements in arousal index and snoring intensity were also noted in adults. Combining MT with continuous positive airway pressure (CPAP) could lead to a pronounced reduction in AHI but did not significantly increase CPAP efficacy. Limited evidence suggests MT may benefit AHI and average SpO2 in pediatric OSA, with high compliance being essential.

Conclusions

The network meta-analysis supports MT as a promising adjunct for improving subjective indicators in adults and suggests that when daily training exceeds 30 minutes, MT can significantly improve AHI. Additionally, MTSP and MT combined with myofascial release may offer further benefits in subjective outcomes.

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来源期刊

Journal of Evidence-Based Dental Practice DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

6.00

自引率

16.70%

发文量

105

审稿时长

28 days

期刊介绍： The Journal of Evidence-Based Dental Practice presents timely original articles, as well as reviews of articles on the results and outcomes of clinical procedures and treatment. The Journal advocates the use or rejection of a procedure based on solid, clinical evidence found in literature. The Journal''s dynamic operating principles are explicitness in process and objectives, publication of the highest-quality reviews and original articles, and an emphasis on objectivity.