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Fransson A, Nohlert E, Tegelberg Å, Isacsson G. Gender differences in oral appliance treatment of obstructive sleep apnea. Sleep Breath 2024; 28:1723-1730. [PMID: 38772967 PMCID: PMC11303471 DOI: 10.1007/s11325-024-03019-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Although overall success rates for treating obstructive sleep apnea (OSA) with an oral appliance (OA) are high, they are significantly higher among females. To verify published data, the study's purpose was to evaluate a participant sample after one year of OA use. The primary outcome was treatment response, with responders defined as having an apnea-hypopnea index (AHI) < 10 at follow-up and/or reduced by ≥50% of baseline. Secondary measures were from standardized questionnaires. METHODS A sample of 314 participants, predominately with moderate-to-severe OSA, were enrolled and instructed to use an OA every night. At baseline and one-year follow-up, polygraphic recordings and questionnaires, including sleepiness (measured using the Epworth sleepiness scale) and quality-of-life (measured using the Functional Outcomes of Sleep Questionnaire), were collected. RESULTS Among the 314 participants, 192 completed the one-year evaluation: 51 females (27%) and 141 males (73%). Overall, OA treatment resulted in 78% and 77% responders among females and males, respectively. Neither the difference in improvement nor the absolute change in AHI differed significantly based on gender, at any OSA severity level. There were no significant gender differences in sleepiness or quality of life. Treatment-related adverse reactions were more common among females. CONCLUSION Both females and males with OSA respond well to OA therapy, with nonsignificant gender differences in outcomes. Thus, the hypothesis that females respond better to OA treatment is rejected.
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Affiliation(s)
- Anette Fransson
- Department of Research, Örebro University Hospital, Region Örebro County and Faculty of Medicine Health, Örebro University, Örebro, Sweden.
| | - Eva Nohlert
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Åke Tegelberg
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
- Department of Orofacial pain and jaw function, Malmö University, Malmö, Sweden
| | - Göran Isacsson
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
- Department of Orofacial Pain and jaw function, Västmanland Hospital, Västerås, Sweden
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Tao Z, Zhao T, Ngan P, Qin D, Hua F, He H. THE USE OF DENTAL PATIENT-REPORTED OUTCOMES AMONG RANDOMIZED CONTROLLED TRIALS IN ORTHODONTICS: A METHODOLOGICAL STUDY. J Evid Based Dent Pract 2023; 23:101795. [PMID: 36707165 DOI: 10.1016/j.jebdp.2022.101795] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify and summarize the use and characteristics of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) within randomized controlled trials (RCTs) published in 5 leading orthodontic journals. METHODS A manual search was conducted to identify intervention (therapeutic or preventive) related RCTs published in selected journals between 2015 and 2021. Two authors extracted the characteristics of each included trial, as well as all outcomes and outcome measures used in these trials independently and in duplicate. Thereafter, the use of dPROs and dPROMs was identified and summarized. We classified all dPROs into 2 general types (oral health-related quality of life [OHRQoL] and others) and dPROMs into 3 categories (single-item questionnaires, generic multiple-item questionnaires, and specific multiple-item questionnaires). We also identified whether these dPROMs assessed 4 dimensions of OHRQoL (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). RESULTS From 4631 examined articles, a total of 315 RCTs were included, of which 76 (24.1%) used dPROs and dPROMs. Eight different dPROs (OHRQoL, patients' satisfaction with treatment, difficulty, compliance, preference, efficacy, duration, and unwanted events) and 34 different dPROMs (including 13 single-item questionnaires, 7 generic multiple-item questionnaires, and 14 specific multiple-item questionnaires) were identified in these trials. OHRQoL was the most commonly used dPRO (n = 71; 93.4%), followed by patients' satisfaction with treatment (n = 10; 13.2%), patient-reported difficulty (n = 5; 6.6%), and patient-reported compliance (n = 4, 5.3%). The 4 most frequently used dPROMs were pain measured with 10 mm Visual Analogue Scale (n = 20; 24.1%), pain measured with Numerical Rating Scale (n = 11; 13.3%), the Feldmann's Questionnaire (2007) (n = 6; 7.2%), and the Oral Health Impact Profile 14 (n = 5; 6.0%). CONCLUSION Only about one-fourth of RCTs published in leading orthodontic journals can reflect patients' perspectives. OHRQoL was the most commonly used dPRO in these trials. Substantial heterogeneity exists among dPROMs used for OHRQoL assessment. Efforts are needed from researchers, reviewers, editors and other stakeholders to promote the wide and standardized use of dPROs in orthodontic research.
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Affiliation(s)
- Zhendong Tao
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tingting Zhao
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, United States of America
| | - Danchen Qin
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
| | - Hong He
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Sleep architecture, obstructive sleep apnea and functional outcomes in adults with a history of Tick-borne encephalitis. PLoS One 2021; 16:e0246767. [PMID: 33556106 PMCID: PMC7870069 DOI: 10.1371/journal.pone.0246767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/25/2021] [Indexed: 01/02/2023] Open
Abstract
Tick-borne encephalitis (TBE) is a widespread viral infection of the central nervous system with increasing incidence in Europe and northern Asia. Post-infectious sequelae are frequent, and patients with TBE commonly experience long-term fatigue and subjective sleep disturbances. Obstructive sleep apnea (OSA) may be a contributing factor, and objective sleep studies with polysomnography (PSG) are lacking. Forty-two adults, 22 TBE patients (cases), diagnosed in Region Västra Götaland, Sweden, between 2012 and 2015, and 20 controls without a known TBE history, underwent an overnight PSG, respectively. All participants responded to questionnaires. The cases and controls were similar regarding age, sex, obesity, concomitant diseases, smoking, and alcohol habits. Despite similar PSG characteristics such as total sleep time and OSA severity indices, the TBE cases reported statistically more sleep-related functional impairment on the Functional Outcome of Sleep Questionnaire (FOSQ) compared with the controls (median scores 18.1 vs. 19.9; p<0.05). In a multivariate analysis, TBE correlated significantly with the lower FOSQ scores (unstandardized β -1.80 [%95 confidence interval -3.02 - -0.58]; p = 0.005) independent of age, sex, total sleep time and apnea-hypopnea-index. TBE cases with OSA reported the lowest scores on the FOSQ compared with the other subgroups with TBE or OSA alone, and the ones with neither TBE nor OSA. TBE is associated with impaired functional outcomes, in which concomitant OSA may worsen the subjective symptoms. Further studies are warranted to determine the effect of treatment of concomitant OSA on functional outcomes with regard to optimal rehabilitation of TBE.
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Are the International Classification of Functioning, Disability and Health (ICF) domains considered in the obstructive sleep apnea instruments? An integrative review. Sleep Breath 2020; 25:1089-1100. [PMID: 32865728 DOI: 10.1007/s11325-020-02173-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Obstructive Sleep Apnea (OSA) is related to cardiovascular, metabolic, and neurocognitive diseases. Furthermore, OSA symptoms, such as excessive sleepiness, fatigue, and mood disorders, may interfere in functioning. The assessment of this aspect in patients with OSA is not frequent and no specific instrument is available in the literature. Our aim is to identify if the International Classification of Functioning, Disability and Health (ICF) domains are considered in the validated instruments used to assess patients with OSA. METHODS In this integrative literature review, three databases were searched: Pubmed, Embase, and LILACS. Bibliographic survey was carried out in 2020, between March and July. Articles published in English, Portuguese, and Spanish with validated tools to assess OSA in adults were included. RESULTS Thirty instruments have undergone a process of concept extraction and coding according to the ICF, generating a total of 769 significant concepts. It was observed that the function domain was the most prevalent, making 42% (n = 323) of the concepts, followed by domains of activity (16%), participation (10%), environmental factors (5%), personal factor (5%), and structure (1%). Only one instrument, the "Sleep Apnea Quality of Life Index (SAQLI)," encompasses all domains of the ICF in its constructs. CONCLUSION In the analyzed instruments, the function domain prevails, with most concepts related to sleep functions. Only one validated instrument included in this research covered all the ICF domains. This instrument closely matched the recommended way of assessing functioning, though it approached the domains in an unbalanced way.
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Isacsson G, Nohlert E, Fransson AMC, Bornefalk-Hermansson A, Wiman Eriksson E, Ortlieb E, Trepp L, Avdelius A, Sturebrand M, Fodor C, List T, Schumann M, Tegelberg Å. Use of bibloc and monobloc oral appliances in obstructive sleep apnoea: a multicentre, randomized, blinded, parallel-group equivalence trial. Eur J Orthod 2019; 41:80-88. [PMID: 29771314 PMCID: PMC6343726 DOI: 10.1093/ejo/cjy030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The clinical benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that the two types of appliances are equally effective in treating OSA. Objective To compare the efficacy of monobloc versus bibloc appliances in a short-term perspective. Patients and methods In this multicentre, randomized, blinded, controlled, parallel-group equivalence trial, patients with OSA were randomly assigned to use either a bibloc or a monobloc appliance. One-night respiratory polygraphy without respiratory support was performed at baseline, and participants were re-examined with the appliance in place at short-term follow-up. The primary outcome was the change in the apnoea–hypopnea index (AHI). An independent person prepared a randomization list and sealed envelopes. Evaluating dentist and the biomedical analysts who evaluated the polygraphy were blinded to the choice of therapy. Results Of 302 patients, 146 were randomly assigned to use the bibloc and 156 the monobloc device; 123 and 139 patients, respectively, were analysed as per protocol. The mean changes in AHI were −13.8 (95% confidence interval −16.1 to −11.5) in the bibloc group and −12.5 (−14.8 to −10.3) in the monobloc group. The difference of −1.3 (−4.5 to 1.9) was significant within the equivalence interval (P = 0.011; the greater of the two P values) and was confirmed by the intention-to-treat analysis (P = 0.001). The adverse events were of mild character and were experienced by similar percentages of patients in both groups (39 and 40 per cent for the bibloc and monobloc group, respectively). Limitations The study shows short-term results with a median time from commencing treatment to the evaluation visit of 56 days and long-term data on efficacy and harm are needed to be fully conclusive. Conclusion In a short-term perspective, both appliances were equivalent in terms of their positive effects for treating OSA and caused adverse events of similar magnitude. Trial registration Registered with ClinicalTrials.gov (#NCT02148510).
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Affiliation(s)
- Göran Isacsson
- Department of Orofacial Pain and jaw function, Västmanland County Hospital, Västerås, Sweden
| | - Eva Nohlert
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Anette M C Fransson
- Department of Orthodontics, Dental Research, Public Dental Service, Region Örebro County and Faculty of Medicine and Health, Örebro University, Sweden.,Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden
| | | | - Eva Wiman Eriksson
- Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden
| | - Eva Ortlieb
- Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden
| | - Livia Trepp
- Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden
| | - Anna Avdelius
- Department of Orofacial Pain and jaw function, Malmö University, Sweden
| | - Magnus Sturebrand
- Department of Orofacial Pain and jaw function, Västmanland County Hospital, Västerås, Sweden
| | - Clara Fodor
- Department of Orofacial Pain and jaw function, Västmanland County Hospital, Västerås, Sweden
| | - Thomas List
- Department of Orofacial Pain and jaw function, Malmö University, Sweden
| | - Mohamad Schumann
- Department of Orofacial Pain and jaw function, Västmanland County Hospital, Västerås, Sweden
| | - Åke Tegelberg
- Department of Dental Sleep Medicine, Public Dental Service, Region Örebro County, Örebro University, Sweden.,Department of Orofacial Pain and jaw function, Malmö University, Sweden
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Sundman J, Friberg D, Bring J, Lowden A, Nagai R, Browaldh N. Sleep Quality After Modified Uvulopalatopharyngoplasty: Results From the SKUP3 Randomized Controlled Trial. Sleep 2017; 41:4584547. [DOI: 10.1093/sleep/zsx180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joar Sundman
- Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institute, Sweden
| | - Danielle Friberg
- Department of Otorhinolaryngology, Institute of Surgical Science, Uppsala University, Sweden
| | | | - Arne Lowden
- Stress Research Institute, Stockholm University, Sweden
| | - Roberta Nagai
- Stress Research Institute, Stockholm University, Sweden
| | - Nanna Browaldh
- Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institute, Sweden
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Tsai SY, Shun SC, Lee PL, Lee CN, Weaver TE. Validation of the Chinese Version of the Functional Outcomes of Sleep Questionnaire-10 in Pregnant Women. Res Nurs Health 2016; 39:463-471. [PMID: 27545720 DOI: 10.1002/nur.21750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 12/25/2022]
Abstract
We evaluated the psychometric properties of a Mandarin Chinese version of the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) in pregnant women. A total of 228 first-trimester pregnant women participated in the study, which was conducted in an outpatient obstetric clinic at a medical center in Taipei, Taiwan. The Chinese version of the FOSQ-10 demonstrated satisfactory internal consistency (Cronbach alpha = .85), adequate corrected item-total correlations (from .40 to .67), and acceptable test-retest reliability over 7 days (ICC = .73). Construct validity was supported by exploratory factor analysis showing a one-factor structure with item loadings between .49 and .77. Significant associations with the Medical Outcomes Study Short-Form Health Survey 12 version 2 and Pittsburgh Sleep Quality Index supported criterion-related and convergent validity. Significant differences in the Chinese version of the FOSQ-10 total scores were found between women with clinically significant daytime sleepiness and those without, suggesting adequate discriminant validity. Ceiling effects were observed for all items, but no floor or ceiling effects were found for total scores. Findings suggest that the Chinese version of the FOSQ-10 is a valid and reliable instrument to identify important effects of sleep-related impairment in Chinese women during pregnancy. Further testing is needed in more diverse pregnant women, such as women with complicated pregnancies and those with sleep disorders. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Shao-Yu Tsai
- Associate Professor, School of Nursing, National Taiwan University, No. 1, Sec. 1, Jen-Ai Rd., Taipei, Taiwan, 10051
| | - Shiow-Ching Shun
- Associate Professor, School of Nursing, National Taiwan University, Taipei, Taiwan
| | - Pei-Lin Lee
- Assistant Professor, Department of Internal Medicine, National Taiwan University, Director, Center of Sleep Disorder, Attending Physician, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Nan Lee
- Professor, Department of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan
| | - Terri E Weaver
- Dean and Professor, College of Nursing, University of Illinois at Chicago, Chicago, IL
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Han NE, Kim DY, Lee SA. Validity of Korean Version of Functional Outcomes of Sleep Questionnaire in Patients with Simple Snoring and Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2014. [DOI: 10.17241/smr.2014.5.1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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