Dados do Trabalho

Título

ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP APNEA AND TEMPOROMANDIBULAR DISORDERS: A META-ANALYSIS

Introdução

Obstructive Sleep Apnea (OSA) is one of the most common sleep disorders in patients with Temporomandibular Disorders (TMD). Extensive literature has shown that this problem can precede the onset of TMD or worsen symptoms, which could negatively impact treatment response.

Objetivo

The aim of this meta-analysis was to answer the following question: “Is there an association between Obstructive Sleep Apnea and Temporomandibular Disorders in adults?”.

Métodos

Two reviewers searched for observational studies assessing the association between TMD and OSA published in six main databases, three from gray literature. To be eligible, studies had to include adults (>18 years), with no language, gender or time of publication restrictions, using either RDC/TMD or DC/TMD for TMD diagnosis and validated questionnaires and/or polysomnography (PSG) used for OSA. Furthermore, studies should had a comparison with healthy controls. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. An association meta-analysis was performed for dichotomous outcomes using Odds Ratio (OR) and the Mantel-Haenszel analysis method. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.

Resultados

Of the 2266 articles received only six met the inclusion criteria for quantitative analyses. Of them, OSA was assessed by PSG (the gold-standard for OSA diagnosis) in only two papers and in the other four by validated questionnaires (which suggest OSA signs and symptoms). Based on data from the meta-analysis and from the limited number of included studies the differences in the overall odds of having OSA in TMD patients favor a positive association (OR=3.06; 95% CI=1.72 to 5.44). High values for the I2 (91%) and Tau2 (0.44) tests were observed, suggesting that the included studies were notably heterogeneous in their reported effect size.

Conclusões

• In general, TMD patients had a statistically positive association with OSA within an OR of 3.06.
• Against this background, OSA screening should be a routine part of the diagnostic assessement of patients with TMD.
• Given the various OSA assessment methods used and current small number of included studies, a larger number of studies with PSG OSA diagnostic are needed to better investigate this association.

Palavras -chave

temporomandibular disorders, obstructive sleep apnea, systematic review.