TY - JOUR
T1 - Factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea
T2 - a systematic review and meta-analysis
AU - Tallamraju, Harishri
AU - Newton, J Tim
AU - Fleming, Padhraig S
AU - Johal, Ama
N1 - © 2021 American Academy of Sleep Medicine.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Study Objectives: The review aimed to identify the factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea. Methods: The protocol was initially registered with the International Register of Systematic Reviews (Prospero: CRD42019122615) prior to undertaking a comprehensive electronic search of databases and references without language and date restrictions. Quality assessment was undertaken using the Cochrane Collaboration's risk of bias tool and Quality in Prognosis Studies (QUIPS) tool. Results: Studies exhibited low or unclear risk of bias for the domains assessed by the respective quality assessment tools. The influence of independent variables such as disease characteristics, patient characteristics, appliance features, and psychological and social factors on adherence levels was also assessed. There was a total of 31 included studies, which consisted of 8 randomized controlled trials, 2 controlled clinical trial, 7 prospective cohorts, 11 retrospective cohorts, and the remaining 3 studies were a case-series, case-control, and a mixed-methods. All 31 included studies were subject to qualitative analysis, with only 4 studies included in the quantitative analysis. Results of the meta-analysis demonstrated increased adherence with custom-made appliances, with a pooled mean difference of -1.34 (-2.02 to -0.66) and low levels of heterogeneity (I2 = 0%). Conclusions: A weak relationship was observed between objective adherence and patient and disease characteristics, such as age, sex, obesity, apneahypopnea index, and daytime sleepiness, to oral appliance therapy. Nonadherent patients reported more side effects with oral appliance therapy than users and tended to discontinue the treatment within the first 3 months. Custom-made oral appliances were preferred and increased adherence reported in comparison to ready-made appliances. Further research is imperative to examine the relationship between psychosocial factors and adherence to oral appliance therapy.
AB - Study Objectives: The review aimed to identify the factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea. Methods: The protocol was initially registered with the International Register of Systematic Reviews (Prospero: CRD42019122615) prior to undertaking a comprehensive electronic search of databases and references without language and date restrictions. Quality assessment was undertaken using the Cochrane Collaboration's risk of bias tool and Quality in Prognosis Studies (QUIPS) tool. Results: Studies exhibited low or unclear risk of bias for the domains assessed by the respective quality assessment tools. The influence of independent variables such as disease characteristics, patient characteristics, appliance features, and psychological and social factors on adherence levels was also assessed. There was a total of 31 included studies, which consisted of 8 randomized controlled trials, 2 controlled clinical trial, 7 prospective cohorts, 11 retrospective cohorts, and the remaining 3 studies were a case-series, case-control, and a mixed-methods. All 31 included studies were subject to qualitative analysis, with only 4 studies included in the quantitative analysis. Results of the meta-analysis demonstrated increased adherence with custom-made appliances, with a pooled mean difference of -1.34 (-2.02 to -0.66) and low levels of heterogeneity (I2 = 0%). Conclusions: A weak relationship was observed between objective adherence and patient and disease characteristics, such as age, sex, obesity, apneahypopnea index, and daytime sleepiness, to oral appliance therapy. Nonadherent patients reported more side effects with oral appliance therapy than users and tended to discontinue the treatment within the first 3 months. Custom-made oral appliances were preferred and increased adherence reported in comparison to ready-made appliances. Further research is imperative to examine the relationship between psychosocial factors and adherence to oral appliance therapy.
UR - http://www.scopus.com/inward/record.url?scp=85112490202&partnerID=8YFLogxK
U2 - 10.5664/jcsm.9184
DO - 10.5664/jcsm.9184
M3 - Review article
C2 - 33660611
SN - 1550-9389
VL - 17
SP - 1485
EP - 1498
JO - Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
JF - Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
IS - 7
ER -
