We aim to conduct an overview of reviews re-analyzing outcome data from SRs on the efficacy of MT, on multiple outcomes, in OSA patients.
We searched PubMed, Embase, and the Cochrane Library up to June 2024 for SRs with meta-analyses on adults or children with OSA who underwent MT intervention compared to any control. Primary outcomes were severity of sleep apnea, oxygen saturation, sleep efficiency and daytime sleepiness, while secondary included snoring intensity and frequency, and sleep quality. Two reviewers independently screened papers, extracted data and assessed risk of bias of SRs and their included primary studies. The degree of overlap between the SRs, both at the outcome and study level, was quantified by calculating the Corrected Covered Area. We re-analyzed outcome data from primary studies by performing meta-analyses, on different comparisons, according to the study design.
We selected nine SRs including overall 20 unique primary studies (377 participants). Nearly all primary studies (n=19) recruited adults. The degree of overlap between the primary studies included in the SRs was high. Risk of bias was generally high in randomized controlled trials (RCTs) (n=13) and fair in pre-post studies (n=5).
Meta-analyses showed that in adults, MT was more effective than control in reducing severity of sleep apnea (MD -9.54; CIs 95% -14.04, -5.04), daytime sleepiness (MD -3.62; CIs 95% -6.61, -0.63), snoring intensity and frequency (MD -0.58; CIs 95% -1.15, -0.02; MD -2.38; CIs 95% -3.76, -0.99), sleep quality (MD -2.23; CIs 95% -2.93, -1.53), and in improving minimum oxygen saturation (MD 3.19; CIs 95% 1.47, 4.91). Only one study assessed MT in association to continuous positive airway pressure (CPAP) vs. CPAP alone, with no differences between groups. No differences were found in mean oxygen saturation and sleep efficiency. Meta-analyses comparing pre-MT to post-MT showed general improvements post-MT. The single study investigating the effects of MT on children, reported better outcomes for patients undergoing OSA treatment with oral appliance compared to MT.
MT may have the potential to improve multiple clinical outcomes in OSA patients. These findings highlight MT potential as a valuable component in OSA management strategies. However, results should be interpreted cautiously, as most primary studies are at high risk of bias. Research on pediatric population is limited, making it difficult to draw conclusions on OSA effects in children.
MT for adults could be considered the treatment of choice for individuals who do not adhere to or refuse CPAP. Future studies should consider the severity of OSA, as it may impact the effectiveness of MT treatment, and to include larger numbers of participants and diverse populations.
Obstructive Sleep Apnea
Overview of reviews
