Craniofacial structure and obstructive sleep apnea syndrome - A qualitative analysis and meta-analysis of the literature
Craniofacial structure and obstructive sleep apnea syndrome - A qualitative analysis and meta-analysis of the literature
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DOI：
10.1016/s0889-5406(96)70177-4
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发表时间：
1996-02-01
影响因子：
3
通讯作者：
Rockette, HE
中科院分区：
文献类型：
--
作者：
Miles, PG;Vig, PS;Rockette, HE
颅面结构与阻塞性睡眠呼吸暂停综合征（OSAS）的病因学相关性是有争议的，但因果关系的前提可以证明许多治疗的合理性。对文献进行定性和定量分析，以检查颅面结构与OSAS之间关系的基础。对已发表和未发表的关于诊断成像和OSAS的文献进行了MEDLINE检索和调查。每个样本研究通过以下标准进行评估：(a)适当的对照组，(b)评估者的“盲法”，(c)测量的可靠性，(d)随机分配治疗，以及(e)在疗效研究中充分定义“成功”。形态学变量被合并在研究中，并与来自与OSAS组相同患者群体的对照进行比较，或与性别、年龄和体重指数相匹配。分析结果包括32篇综述文章、16份病例报告和95份样本研究。只有7个样本研究从相同的患者池中抽取了一个对照组，而5个样本研究使用了匹配的对照组。这些研究中只有一项符合所有的定性标准。在治疗疗效研究中，10项研究充分定义了结果。然而，这些都不符合所有的定性标准。下颌平面到舌骨、下颌平面角度和下颌体长是最一致的、最强的效应量，具有最高的潜在诊断准确性。只有下颌体长与OSAS的诊断准确性和临床意义相关。然而，由于该变量的对照是从文献中选择的，因此对正相关的可能解释包括研究之间的方法学差异、不同的放大因子和形态差异。
The etiologic relevance of craniofacial structure to obstructive sleep apnea syndrome (OSAS) is controversial yet the premise of a causal association serves to justify many treatments. A qualitative and quantitative analysis of the literature was performed to examine the foundation for any relationship between craniofacial structure and OSAS. A MEDLINE search and investigation of the published and unpublished literature on diagnostic imaging and OSAS was toxonomically arranged. Each sample study was evaluated by using the following criteria: (a) appropriate control group, (b) ''blinding'' of evaluators, (c) reliability measured, (d) random assignment of treatment, and (e) ''success'' was defined adequately in efficacy studies. Morphologic variables were combined among studies and compared with controls drawn from either the same patient pool as the OSAS group, or matched for gender, age, and body mass index. Analysis revealed 32 review articles, 16 case reports, and 95 sample studies. Only seven sample studies drew a control group from the same patient pool, whereas five used matched controls. Only one of these studies satisfied all the qualitative criteria. Of the treatment efficacy studies, 10 defined outcome adequately. However, none of these met all the qualitative criteria. The most consistent, strong effect sizes with the highest potential diagnostic accuracies were for mandibular plane to hyoid, mandibular plane angle, and mandibular body length. Only mandibular body length demonstrated a clinically significant association with and diagnostic accuracy for OSAS. However, since this variable's controls were selected from the literature, possible explanations for a positive association include methodologic differences between studies, varying magnification factors, and morphologic differences.