Summary of findings 1. Myofunctional therapy compared to sham therapy for obstructive sleep apnoea.
| Myofunctional therapy compared to sham therapy for obstructive sleep apnoea | ||||||
| Patient or population: obstructive sleep apnoea Setting: Outpatient Intervention: Myofunctional therapy Comparison: Sham therapy | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with sham therapy | Risk with Myofunctional therapy | |||||
| Daytime sleepiness (ESS): endpoint score. Follow‐up: 3 months. | The mean ESS endpoint score was 12.1 | MD 4.52 lower (6.67 lower to 2.36 lower) | ‐ | 82 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | Probably reduces day time sleepiness. Scores from 0 to 24. Lower scores denote lower daytime sleepiness. MCID 3 points. |
| Sleep quality (PSQI): endpoint score. Follow‐up: 3 months. | The mean PSQI endpoint score was 10.8 | MD 3.9 lower (6.31 lower to 1.49 lower) | ‐ | 31 (1 RCT) | ⊕⊕⊝⊝ LOW1 2 | May increase sleep quality. Scores from 0 to 21. Lower scores denote a healthier sleep quality. MCID 3 points. |
| Apnoea Hypopnoea Index: endpoint score. Follow‐up: 3 months. | The mean AHI endpoint score was 28.8 events/hour | MD 13.2 events/hour lower (18.48 lower to 7.93 lower) | ‐ | 82 (2 RCTs) | ⊕⊕⊝⊝ LOW1 2 | May result in a large reduction of AHI events per hour. Lower scores better. MCID 5 points. |
| Snoring frequency: change from baseline. Follow‐up: 3 months. | The mean snoring frequency change from baselines was ‐6.2 | MD 43.07 lower (84.63 lower to 1.51 lower) | ‐ | 16 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 2 3 4 | May have little to no effect in reduction of snoring frequency but the evidence is very uncertain. Subjective snoring frequency, endpoint analysis: MD 2.2 lower (3.96 lower to 0.44 lower; one study, 51 participants). Lower scores better. MCID: not available. |
| Snoring intensity: endpoint score. Follow‐up: 3 months. | The mean snoring intensity endpoint score was 6.2 | MD 1.9 lower (3.69 lower to 0.11 lower) | ‐ | 51 (1 RCT) | ⊕⊕⊕⊝ MODERATE 1 | Probably reduces subjective snoring intensity slightly. Subjective VAS. Lower scores better. MCID: not available. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). AHI: apnoea hypopnoea index; CI: Confidence interval; ESS: Epworth sleepiness scale; MD: mean difference; MCID: Minimal Clinically Important Diference; PSQI: Pittsburgh Sleep Quality Index; VAS: Visual Analog Scale | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded one point for Incomplete outcome data
2 Downgraded one point for imprecision
3 Downgraded one point for unblinded
4 Downgraded one point for concealment not done