Associação entre apneia obstrutiva do sono e disfunção temporomandibular: Uma revisão sistemática e meta-análise

Abstract

Obstructive sleep apnea (OSA) is a very common condition in patients with temporomandibular disorders (TMD). However, there is little evidence of the connection between them. The aim of this systematic review (SR) was to assess the association between obstructive sleep apnea (OSA) and temporomandibular disorders (TMD) in the adult population. TMD should be diagnosed using Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) and OSA using polysomnography (PSG) and/or validated questionnaires (QV). All studies were compared to healthy controls and there were no restrictions on language, gender or time of publication. Case-control, cross-sectional and cohort studies of the association between TMD and OSA were searched up to November 2022 in the EMBASE, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Open Gray and Pro Quest databases. Risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklists. An association meta-analysis was performed using the Review Manager software, version 5.4. The effect measure included the odds ratio (odds ratio) in dichotomous variables and a 95% confidence interval (CI). Certainty of evidence was determined by analyzing groups using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered in PROSPERO, under number CRD42021240373. Of the 1024 articles received, seven met the inclusion criteria for the SR and six were included in the quantitative analysis (one study was excluded due to insufficient data), with all articles found to be at low risk of bias. The odds ratio (OR) of OSA in patients with TMD showed a positive association (OR=2.61; 95% CI=2.31,2.95 ) in the quantitative analysis covering all studies. Two additional meta-analyses were performed to group studies by OSA diagnostic method. Studies using the OSA diagnostic method by PSG and VQ (OR= 2.74; 95%CI= 2.11,3.57 ) and studies using only VQ (OR = 2.55; 95% CI = 2.22,2.92). Another sensitivity MA without the larger population study, still showed a positive association of OSA in patients with TMD (OR= 2.48; CI= 95% 1.93,3.18). Analysis of evidence certainly was moderate. Patients with TMD had a statistically significant association with OSA regardless of the OSA diagnostic method (PSG and/or VQ). Against this background, OSA screening should be a routine part of the diagnosis of patients with TMD. However, due to the different OSA assessment methods used and the small number of studies included, it is necessary to include a larger number of studies with PSG in order to better investigate this association.