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      Alternatives to continuous positive airway pressure treatment in sleep apnoeas and hypopnoeas syndrome related to myofunctional and postural reeducation therapy: protocol for a systematic review

      systematic-review

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          Abstract

          Introduction

          The main treatment for sleep apnoeas and hypopnoeas syndrome (SAHS) is continuous positive airway pressure (CPAP). However, patients sometimes do not adhere to the treatment protocol. Supplementary and complementary therapies have appeared as alternatives. Some of the therapies which are especially important are those related to myofunctional (MFT) and postural therapy (PT), as all of them are non-invasive, and their application is simpler than that of CPAP. We aim to present a protocol for a systematic review and meta-analysis for investigating new SAHS treatments, including the protocols and frequency of use and the effects they have on patient signs, symptoms and quality of life.

          Methods and analysis

          The literature search will be conducted using the Cochrane, Web of Science, Medline (via PubMed) and Scopus databases, from January 2020 to December 2020. All types of studies written in English and Spanish that investigate the use of alternative SAHS treatments related to MFT, or more importantly, the combination of MFT and PRT, will be selected. To evaluate their quality, the Critical Appraisal Checklist for Analytical Cross-Sectional will be applied. The primary factor valued in the studies will be the inclusion of MFT and PT reeducation in the treatment. Subgroup analyses will be carried out evaluating the specific type of treatments chosen and the improvements or deteriorations in the level of health and quality of life in the patients. Finally, several patient-related outcomes, namely sleep quality, quality of life and sleep Apnoeas and Hypoapnoeas Index, will be examined.

          Ethics and dissemination

          In this case, ethical approval is not necessary. The data used in the review will be exclusively obtained from published studies, implying there are no privacy concerns. The information obtained will be relevant to understand if the new treatments applied in SAHS are effective, and if postural and MFT therapy used together can be considered an appropriate approach to treat this disease.

          The results will be published in a peer-reviewed journal.

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          Most cited references24

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          Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

          David Moher, Larissa Shamseer, Mike Clarke … (2017)
          Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
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            Quantifying heterogeneity in a meta-analysis.

            Julian P T Higgins, Simon G Thompson (2002)
            The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity. Copyright 2002 John Wiley & Sons, Ltd.
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              Estimating Effect Sizes From Pretest-Posttest-Control Group Designs

              S. Morris (2008)
              Article 0 comments Cited 386 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2021
                Publication date (Electronic): 2 December 2021
                Volume: 11
                Issue: 12
                Electronic Location Identifier: e049286
                Affiliations
                [1 ]departmentFaculty of Nursing , Universidad de Castilla-La Mancha , Cuenca, Spain
                [2 ]departmentFaculty of Education , Universidad de Castilla-La Mancha , Cuenca, Spain
                [3 ]departmentInternity Medicine , Hospital Virgen de la Luz , Cuenca, Spain
                [4 ]departmentFaculty of Phsysiotheray , Universidad de Castilla-La Mancha - Campus de Toledo , Toledo, Spain
                [5 ]departmentFacultad de Farmacia , Universidad Complutense de Madrid , Madrid, Spain
                Author notes
                [Correspondence to ] Mrs Natalia María Arias-Palencia; natalia.arias@ 123456uclm.es
                Author information
                http://orcid.org/0000-0001-5004-3197
                http://orcid.org/0000-0003-4034-2585
                Article
                Publisher ID: bmjopen-2021-049286
                DOI: 10.1136/bmjopen-2021-049286
                PMC ID: 8640639
                PubMed ID: 34857560
                SO-VID: d616a54f-1088-455d-a39c-4466454b5aa2
                Copyright © © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 14 February 2021
                Date accepted : 12 October 2021
                Categories
                Subject: Respiratory Medicine
                Subject: 1506
                Subject: 1731
                Series title: Protocol
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: sleep apnoea,myofunctional therapy,postural therapy,quality of life
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: sleep apnoea, myofunctional therapy, postural therapy, quality of life

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