Orthodontic appliances for the treatment of pediatric obstructive sleep apnea: A systematic review and network meta-analysis

Min Yu; Yanyan Ma; Ying Xu; Jingxuan Bai; Yujia Lu; Fang Han; Xuemei Gao

doi:10.1016/j.smrv.2023.101855

Orthodontic appliances for the treatment of pediatric obstructive sleep apnea: A systematic review and network meta-analysis

Sleep Med Rev. 2023 Dec:72:101855. doi: 10.1016/j.smrv.2023.101855. Epub 2023 Sep 28.

Authors

Min Yu¹, Yanyan Ma², Ying Xu¹, Jingxuan Bai¹, Yujia Lu¹, Fang Han³, Xuemei Gao⁴

Affiliations

¹ Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; National Center for Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China.
² Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China.
³ Sleep Division, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, PR China. Electronic address: hanfang1@hotmail.com.
⁴ Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; National Center for Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China. Electronic address: xmgao@263.net.

PMID: 37820534
DOI: 10.1016/j.smrv.2023.101855

Abstract

This systematic review and network meta-analysis aims to preliminarily investigate the efficacy of different orthodontic appliances for the treatment of pediatric obstructive sleep apnea (OSA). Electronic databases were systematically searched. Randomized and non-randomized controlled trials with patients <18 y treated with either mandibular advancement appliance (MAA), rapid maxillary expansion (RME), or myofunctional therapy (MFT) were included. A network meta-analysis using multivariate random effects was conducted to estimate pooled differences using the apnea-hypopnea index (AHI) as the main outcome. Eleven studies (595 patients) were included in the analysis. Compared with control, MAA was associated with significant reductions in AHI of -2.18/h (95%CI -3.48 to -0.89, p = 0.001). Combined treatment of RME + adenotonsillectomy (AT) and RME + MAA showed a significant decrease in AHI, with -5.13/h (95%CI -7.50 to -2.76, p < 0.0001) and -3.79 (95%CI -5.21 to -2.37, p < 0.0001), respectively. MFT was associated with a -2.45/h (95%CI -4.76 to -0.14, p = 0.038) decrease in AHI. However, RME alone was not associated with significant AHI reduction (0.02, 95%CI -1.72 to 1.75, p = 0.985). The heterogeneity of the network meta-analysis was I² = 32.6%. Limited evidence indicated that MAA (alone or combined with RME) and RME + AT were associated with benefits for pediatric patients with OSA. This study could not find convincing evidence of a significant benefit of other orthodontic appliances over control.

Keywords: AHI; Children; Effect; Orthodontic appliance; Sleep related breathing disorder.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Child
Combined Modality Therapy
Humans
Mandibular Advancement*
Network Meta-Analysis
Orthodontic Appliances
Sleep Apnea, Obstructive* / therapy
Treatment Outcome