Obstructive Sleep Apnoea Hypopnoea Syndrome - Literature review Example

Obstructive sleep apnoea hypopnoea syndrome: The role of socioeconomic and psychosocial factors on the adherence of mandibular advancement appliances Professor: Course: Date Introduction and Approach to the Systematic Review Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is a breathing disorder characterised by breathing difficulty in sleep, causing people to breathe shallowly or stop breathing all together for short periods of time while sleeping.1 The situation is common in men than women, with 4% report in men and 2% report in women who are mostly in their middle-age.2 Because of the importance of breathing to active functioning of the human body, there have been several interventions attempted at resolving this health issue in affected person. For several years, various interventions have focused on the use of biomedical treatments, which have been seen some levels of results but come with its own side effects.3 Because of this, the call for the use of more human friendly interventions has been made. One non-medical intervention that has become common in the treatment of OSAHS is mandibular advancement appliances (MAA). Since the popularisation of its usage, there have been concerns on the factors that impact the adherence to the use of the MAA in patients The current paper is a systematic review that seeks to set a centralised research question, based on which the researcher will try to identify, appraise, choose and synthesize related and high quality research papers that seek to answer the research question. There are a number of modalities that seem to define what a systematic review and how it should be conducted. In a study, Khan et al. noted that, “A review earns the adjective systematic if it is based on a clearly formulated question, identifies relevant studies, appraises their quality and summarizes the evidence by use of explicit methodology”4 .In this, five major steps are identified in the conduct of systematic review. The Cochrane Collaboration (2010) on their part expanded the concept by introducing 8-point general steps in conducting a systematic review. Because Cochrane (2010) builds upon Khan et al. (2003) and almost all the steps from Khan et al. (2003) are absorbed in Cochrane (2010), the researcher used the latter in the current systematic review to find the role of socioeconomic and psychosocial factors on the adherence f mandibular advancement appliance in patients with obstructive sleep apnoea hypopnoea syndrome (OSAHS). The steps which will be elaborated in the systematic review are given as follows: 1. Framing the review questions 2. Searching for articles 3. Selecting articles and collecting data 4. Assessing risk of bias in included articles 5. Analysing data and undertaking meta-analyses 6. Addressing reporting biases 7. Presentation of statistical outline tables 8. Interpretation of results and drawing conclusions5 The Review Questions The review will seek to find answers to the following specific questions. The questions also serve as a guide to the systematic review so that the researcher will not go outside the scope of the questions. The questions are: 1. What is the relationship between the socioeconomic factors and adherence to MMA therapy? 2. What relationship exists between the psychosocial factors and adherence to MMA therapy? Search for Articles The search for articles was a very crucial part of the systematic review as the researcher sought to find the most relevant and suitable sources that would suit the conduct of the study and in helping to answer the research question that had been posed. The search for articles focused on the use of electronic search, whereby the researcher used the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) search strategy tool in finding suitable articles. The SPIDER search strategy tool provided that the researcher used as many clinical databases as possible, whiles focusing on such key search hints as the sample, phenomenon of interest, design, evaluation, and research type used by the researchers whose works were searched. One rationale that informed the use of the SPIDER search strategy tool is that it has been considered highly suitable for qualitative and mixed research.6 Meanwhile, the current study is being conducted as a mixed study that looks into social and ethnographic variables of patients with OSAHS. There were a total of 5 major academic databases used namely Pub Med, EMBASE, OVID, MEDLINE, and science direct. Each of these databases have been used in very long years and approved by various universities for use in medical and other clinical researches.7 It was based on this rationale that they were selected. The search was guided by the use of key words or search terms, which in addition to the SPIDER tool helped in sieving the possible outcomes from the search. The search terms that were used by the researcher included apnoea, mandibular advancement appliance, psycho-economic, psychological factors, self-efficacy, illness perception, coping, compliance, obstructive sleep, and socioeconomic status (S.E.S). In some cases, some search terms were combined with others to ensure that the context of usage stood out clearly. For example, psycho-economic factors + compliance + mandibular advancement appliance formed psycho-economic factors influencing compliance with use of MAA. Selecting Articles and Data Collection In the table below, the key words used, number of hits that were produced, articles selected grey literature used has all been summarised. Databases Search terms No. of Hits Selected Final Articles Grey Literature EMBASE Apnoea, mandibular advancement appliance, psycho-economic 33 results Engleman HM, and Wild MR (2004) NICE guidelines P UB MED Apnoea, psychological factors, self-efficacy 31 results Redline, S et al. (2010). Cochrane Database of Systematic Reviews (CDSR) Science Direct Illness perception, coping, compliance 43 results Vanderveken OM et al. (2013) NICE guidelines OVID Apnoea, psycho-economic, obstructive sleep 38 results Johal A (2006) NICE guidelines MEDLINE S.E.S, OSAHS, self-efficacy 25 results Berger BA (2004) (CDSR) The SPIDER tool really helped in keeping the first line of search to check by ensuring that the first search did not result in so many outcomes that were not going to be necessary for the study. The first search thus produced 170 outcomes. Using various inclusive and exclusive criteria, the articles were systematically reduced till the best and final 5 articles were selected. The inclusion and exclusion criteria provided that with each number of hits; a. Only papers written in English language were included b. Papers that were more than 10 years old were excluded c. Articles that were not full papers were excluded d. Papers with the highest number of search terms were included ahead of those that presented fewer terms e. Authors of articles had to have more than 4 published works After applying the inclusion and exclusion scheme above, there were still more articles than needed with a total of 24 articles found. This led to the use of a scanning process, where the researcher scanned through the table of contents, and abstracts of the 24 articles. This helped in reducing the number to 10. Finally, a skimming process was done by reading through specific chapters of the articles that were in line with the SPIDER acronym. At the end of the search, each database produced 1 quality article that was used in the systematic review as depicted in the table above. Assessing risk of bias in included articles Three of the articles from Engleman and Wild (2004), Redline et al. (2010) and Berger (2004) all gave clear indications of how the researchers dealt with the risk of bias in their study. This was done with focus and emphasis on the sampling procedures used, where the researchers ensured that a randomised sampling technique was employed after they had conducted various inclusion and exclusion criteria to find a population of possible participants. The use of random sampling ensured that the researchers did not have any manipulation over the people that could be included in the study and those that could not be included in the long run.8 In such studies where there is no use of randomisation, researchers have been criticised of possible bias, where there could be preferences with the selection of participants for the study. Such was the case with Johal (2006) and Vanderveken et al. (2013). Whiles trying to find the health-related quality of life in patients with sleep-disordered breathing and the effect of MAA, Johal (2006) limited the sampling procedure to only the use of a pre-determined inclusion and exclusion criteria. At no point in the sampling procedure was randomisation used. In such a situation, there is the risk of bias as the inclusion and exclusion criteria are subjectively based on the considerations of the researcher, thereby increasing chances of preferential selection.9 Even though it has been argued that the exclusive use of inclusion and exclusion criteria ensures that only the best available respondents with the needed variables are selected,10 the fact that it can lead to preferential selection to influence outcome of studies can also not be denied. In Vanderveken et al. (2013), the weakest approach to bias was taken when a purposive sampling devoid of the use of any inclusion and exclusion criteria was used by the researchers. Analysing data and undertaking meta-analyses Each of the five studies selected tried to find key factors that could influence compliance with the use of any form of intervention selected to treat OSAHS. As noted in existing literature, there are several interventions to correcting OSAHS, each of which has its own weaknesses of strengths.11 In general, the interventions may be grouped into medical treatment options and secondary prevention options.12 The chart below gives a statistical representation of the number of studies that made use of each of the options available. Figure 1: Type of OSAHS Intervention in Articles The chart indicates that of the 5 articles, 3 of the used secondary interventions, all of which focused on the use of of Continuous positive airway pressure (CPAP) devices such as MAA. The three studies were Vanderveken et al. (2013), Johal (2006) and Engleman and Wild (2004). The 2 remaining studies used combined interventions made up of medication and MAA. This means that it was possible to assess outcomes from all these studies since there was the usage of MAA as in the current study in all the studies. Each of the 5 studies also attempted to find the key factors that influenced the adherence to the use of MAA in patients with OSAHS. 3 of the studies included socioeconomic factors, whiles 2 included psychosocial factor. In each study, the degree of influence to adherence was measured using the statistical tool of Pearson correlation. In 2 out of 3 studies where socioeconomic factors were measured against adherence, Engleman and Wild (2004), and Johal (2006) recorded positive correlation. This means that there was a chance that a person’s socioeconomic background could influence the level of adherence to the usage of MAA. Vanderveken et al. (2013) however did not see socioeconomic factors as a major influence on adherence. This means that as noted in other studies, chances that a person’s socioeconomic background could influence the use of MAA is higher13 1415. Where psychosocial factors were tested, all two studies by Berger (2004) and Redline et al. (2010) showed positive relation. These findings conform to existing studies where it has been noted that psychosocial factors must be considered by practitioners that want to prescribe MAA for OSAHS patients.16 Addressing reporting biases In terms of the way the studies presented their results, not much can be identified about intentional biases. Reporting scholarly research findings of this nature based on bias greatly affects the quality of research.17 It has been noted that biases affects the reliability of the outcomes as well as generalisability of the findings.18 This is because where such biases are found, it is difficult to generalise or repeat the same study in other settings and expect to achieve the same outcomes.19 In terms of socioeconomic factors, there were three major variables that were common in almost all the studies. These were education, occupation and income. In reporting their findings, the three studies that focused on socioeconomic factors gave equal consideration and attention to each of the constituent variables within the larger variables. For example, in terms of education, those with higher levels of education were given the same level of attention and emphasis as those with low levels of education. This is because the researchers wanted to emphasise on education as a variable rather than knowing which of the two, whether highly educated or less educated could comply with MAA usage. The same was done with occupation and income. Because of this, respondents were asked very general questions such as whether their income levels would influence their adherence to MAA. Regarding psychosocial factors also, the same attempt was followed. There were three variables namely self-efficacy, illness perceptions and coping. Even though the researchers used such scale of measurements as general self-efficacy scale, illness perception questionnaire, and brief coping, the emphasis in reporting was not based on the outcomes of the scaling that was done. Rather, there was a generalisation whether or not the factors could influence adherence. Presentation of statistical outline tables Based on the research questions posed, there are 3 studies that focused on research question 1 and 2 studies that focused on research question 2. The table below gives a statistical outline table of the key findings that were made from the 5 studies in relation to the research questions set. Research Question Article Summary of Findings What is the relationship between the socioeconomic factors and adherence to MMA therapy? Engleman and Wild (2004) 75% of participants indicated that their socioeconomic variables would influence adherence to MAA. Of this, 67% said their education would influence them, 75% said their income would influence adherence, and 82% said their occupation would influence Redline et al. (2010) As many as 83% said their socioeconomic variables would influence adherence to MAA. Of this, the highest factor was income, which was 91%, followed by occupation, which had 81% and 79% selecting education. Berger (2004) Socioeconomic factor scored less than 50% with 38% indicating income would influence adherence, 43% indicating occupation would influence adherence and 32% indicating education would influence usage What relationship exists between the psychosocial factors and adherence to MMA therapy? Johal (2006) 67% was the average rate of influence of psychosocial factors on adherence to MAA. Of this, 65% was influenced by self efficacy, 69% by illness perception and 67% by coping Vanderveken et al. (2013) 70% of overall participants indicated that their psychosocial factor would influence their adherence to MAA. 68%, 70% and 72% attributed to self efficacy, illness perception and coping respectively. Interpretation of results and drawing conclusions It must be stressed that in each case where a correlation was found between the factors and adherence to MAA, the correlation was positive. This can be interpreted as that the higher educated people are, the better their chances of using and adhering to MAA. This can be attributed to the fact that such people understand the medical implications of adherence.20 What is more, people whose occupations consume much of their time are less likely to adhere because they will find adherence another limitation to having a free flowing social lifestyle.21 People who are high income earners are more likely to adhere because these people can easily afford the device and use it on a long term basis, as compared to below with lower S.E.S who struggle on their income. In terms of psychosocial factors also, the influence or correlation drawn are all positive correlations. This means that people with better self efficacy, illness perception and coping mechanism are more likely to stick and stay with the use of MAA.22 To conclude, it would be said that the importance and need to taking into consideration the socioeconomic and psychosocial factors of a person into consideration before deciding to put these people on MAA23. 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