Quality assessment of global obstructive sleep apnea guidelines

Abstract

Objective·To evaluate the quality of clinical practice guidelines of obstructive sleep apnea (OSA) published worldwide.Methods·The guidelines of OSA were retrieved in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, SinoMed, MedSci, The Cochrane Library, and the websites such as Medlive, U. S. Preventive Services Task Force (USPSTF), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Scottish Intercollegiate Guidelines Network (SIGN), and Guidelines International Network (GIN) from establishment to December 2022. Two reviewers screened the literature and extracted the main information independently, using the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) and Reporting Items for Practice Guidelines in Healthcare (RIGHT) to evaluate the quality of the included OSA guidelines. Subgroup analysis was performed according to the publication regions of guidelines. The inter-evaluator consistency test was also performed and the results were expressed as the intra-class correlation coefficient (ICC). All the included guidelines were read entirely and the clinical questions they raised were summarized.Results·A total of 35 OSA guidelines were included. The ICC value of 0.975 showed a good inter-evaluator agreement. The results of AGREE Ⅱ showed that the average score of all guidelines was (63.60±16.45)%, with a minimum of 23.40% and a maximum of 91.67%. In the six domains, the scores of "Rigor of development" [(56.07±25.89)%] and "Applicability" [(53.57±15.52)%] were relative low. The average reporting rate of RIGHT of all the included guidelines was (67.84±20.03)%, with a minimum of 14.29% and a maximum of 94.29%, and the three domains with the lowest reporting rates were "Review and quality assurance" [(31.40±45.51)%], "Funding and conflict of interest declaration and management" [(56.43±33.95)%] and "Other aspects" [(56.19±36.85)%]. Subgroup analysis showed that guidelines in Asian had a lower score in "Rigor of development" and a lower overall score of AGREE Ⅱ than the guidelines in America and Europe (both P<0.05), and the reporting rates in the domains of "Evidence" and "Other information" of RIGHT of the Asian guidelines were also lower than those in the guidelines in America and Europe (P<0.05). These guidelines focused on 42 clinical questions which were classified to 3 aspects, i.e. screening and diagnosis, treatment and long-term management of OSA.Conclusion·The quality of current global OSA guidelines varies a lot, and they need to be strengthened in terms of rigor of development, applicability, review and quality assurance, funding and conflict of interest declaration and management, especially those in Asia.

Keywords

• obstructive sleep apnea (osa)
• clinical practice guideline
• quality assessment
• systematic review