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. 2020 Nov 3;2020(11):CD013449. doi: 10.1002/14651858.CD013449.pub2

Summary of findings 4. Myofunctional therapy compared to CPAP + Myofunctional therapy for obstructive sleep apnoea.

Myofunctional therapy compared to CPAP + Myofunctional therapy for obstructive sleep apnoea
Patient or population: obstructive sleep apnoea
Setting: Outpatient
Intervention: Myofunctional therapy
Comparison: CPAP + Myofunctional therapy
Outcomes Anticipated absolute effects* (95% CI) Relative effect
(95% CI) № of participants
(studies) Certainty of the evidence
(GRADE) Comments
Risk with CPAP + Myofunctional therapy Risk with Myofunctional therapy
Daytime sleepiness (ESS): endpoint score. Follow‐up: 3 months. The mean ESS endpoint score was 7.3 MD 0.2 higher
(2.56 lower to 2.96 higher) 49
(1 RCT) ⊕⊕⊝⊝
LOW1 2 May result in little to no difference in daytime sleepiness.
Scores from 0 to 24. Lower scores denote lower daytime sleepiness. MCID 3 points.
AHI: endpoint score. Follow‐up: 3 months. The mean AHI endpoint score was 3.4 events/hour MD 10.5 events/hour higher
(3.43 higher to 17.57 higher) 49
(1 RCT) ⊕⊕⊝⊝
LOW1 2 May increase AHI.
Events per hour. Lower scores better. MCID 5 points.
Snoring frequency: endpoint score. Follow‐up: 3 months. The mean snoring frequency endpoint score was 3.9 MD 1 higher
(1.13 lower to 3.13 higher) 49
(1 RCT) ⊕⊕⊝⊝
LOW1 2 May result in little to no difference in snoring frequency.
Subjective VAS. Lower scores better. MCID: not available.
Snoring intensity: endpoint score. Follow‐up: 3 months. The mean snoring intensity endpoint score was 3.1 MD 1.2 higher
(0.5 lower to 2.9 higher) 49
(1 RCT) ⊕⊕⊝⊝
LOW1 2 May result in little to no difference in snoring intensity.
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
GRADE Working Group grades of evidenceHigh 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