METHODS: Two blinded reviewers searched PubMed, Embase, Scopus, Web of Science, and IEEE Xplore databases, then selected and graded the risk of bias of observational studies of adults (≥ 18 years) comparing the diagnostic performance of AI algorithms using craniofacial photographs, versus conventional OSA diagnostic criteria (i.e. apnea-hypopnea index [AHI]). Studies were excluded if they detected apneic events without diagnosing OSA. AI models evaluated with a random split test set or k-fold cross-validation were included in a Bayesian bivariate meta-analysis.
RESULTS: From 5,147 records, 6 studies were included, containing 10 AI models trained/tested on 1,417/983 participants. The risk of bias was low. AI trained on craniofacial photographs achieved a pooled 84.9% sensitivity (95% credible interval [95% CrI]: 77.1-90.7%) and 71.2% specificity (95% CrI: 60.7-81.4%). Bayesian meta-regression identified deep learning (convolutional neural networks) as the most accurate AI algorithm (91.1% sensitivity, 79.2% specificity) comparable to home sleep apnea tests. AHI cutoffs, OSA prevalence, feature engineering, input data, camera type and informativeness of Bayesian prior did not alter diagnostic accuracy. There was no substantial publication bias.
CONCLUSION: AI trained on craniofacial photographs have high diagnostic accuracy and should be considered as a low-cost OSA screening tool. Future work focused on deep learning using smartphone images could improve the feasibility of this approach in primary care.
DATA SOURCES: An updated systematic search was performed in three databases until September 4, 2024. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and the protocol was preregistered in PROSPERO (CRD42024546387).
STUDY SELECTION: Randomized controlled trials that studied adult critically ill patients comparing protein doses delivered enterally and/or parenterally with similar energy delivery between groups were included.
DATA EXTRACTION: Data extraction was performed by two authors independently, using a predefined worksheet. The primary outcome was mortality. Posterior probabilities of any benefit (relative risk [RR] < 1.00) or harm (RR > 1.00) and other important beneficial and harmful effect size thresholds were estimated. Risk of bias assessment was performed using the risk of bias 2.0 tool. All analyses were performed using a Bayesian hierarchical random-effects models, under vague priors.
DATA SYNTHESIS: Twenty-two randomized trials ( n = 4164 patients) were included. The mean protein delivery in the higher and lower protein groups was 1.5 ± 0.6 vs. 0.9 ± 0.4 g/kg/d. The median RR for mortality was 1.01 (95% credible interval, 0.84-1.16). The posterior probability of any mortality benefit from higher protein delivery was 43.6%, while the probability of any harm was 56.4%. The probabilities of a 1% (RR < 0.99) and 5% (RR < 0.95) mortality reduction by higher protein delivery were 38.7% and 22.9%, respectively. Conversely, the probabilities of a 1% (RR > 1.01) and 5% (RR > 1.05) mortality increase were 51.5% and 32.4%, respectively.
CONCLUSIONS: There is a considerable probability of an increased mortality risk with higher protein delivery in critically ill patients, although a clinically beneficial effect cannot be completely eliminated based on the current data.