Obstructive sleep apnea (OSA) is a common chronic disorder in children and adolescents that can cause systemic health problems as well as developmental problems. Nasal breathing resistance often associated with craniofacial growth and adenoid and tonsil hypertrophy causes mouth breathing which contributes to OSA. In a systematic review and meta-analysis published February 2015 in the journal Sleep Medicine Reviews, the author’s aim was to “investigate the efficacy of the use of orthopedic mandibular advancement (OMA/aim 1) and rapid maxillary expansion (RME/aim 2) in the treatment of OSA in children and young adolescents.”1
A long narrow face, a transverse deficiency, and retrognathia are factors associated with sleep breathing disorders (SBD) in children. Craniofacial morphology is a stronger risk factor for pediatric SBD than obesity. The first published use of RME therapy dates back to 1860, it was first identified as a possible treatment for pediatric SBD when it was shown to decrease nocturnal enuresis in children, a symptom associated with pediatric SBD.
OMA was also first introduced into dental medicine in 1879 by Dr. Kingley, which he referred to as the “bite-jumping” appliance. OMA can be used for passive or active mandibular growth. In some cases, it is a fixed appliance, while in other cases it is removable and worn at night. Both RME and OMA can be combined as a treatment option in certain cases.
The studies included in the systematic review that evaluated OMA suggested that “it is an interesting and potential treatment for the management of OSA in children and young adolescents.” While studies assessing RME recommended this treatment to “manage OSA in this population.”
There were multiple limitations identified including not adjusting for confounding factors such as “previous adenotonsillectomy versus untreated adenotonsillar hypertrophy.” In some of the published studies, inadequate reporting or lack of reporting data at all leading to improper audit for certain data was noted. Due to these and other challenges, interpretations and diagnostic parameters should be treated carefully. These inconsistencies should be considered as they make an accurate meta-analysis very difficult.
The authors conclude by stating, “The last decade has been marked with pioneer studies resulting in an overall improvement of patient care and underlining the importance of multidisciplinary management of pediatric OSA. Considering the limited number of included studies, the presented orthodontic treatments may be effective in managing pediatric snoring and OSA. Consequently, their respective results suggest that the correction of craniofacial structure imbalances in the optimal conditions afforded by childhood growth may diminish snoring and OSA. Other important health outcomes related to OSA, such as quality of life, neurocognitive function, and cardiovascular health have not yet been systematically addressed and no conclusion on orthodontic treatments should be taken in this regard. Orthodontic treatment of pediatric OSA guidelines cannot be extrapolated and generalized from this systematic review and meta-analysis. In the future, more studies should be conducted with a larger sample size and with specific inclusion and exclusion criteria. The use of the preferred reported items for systematic reviews and meta-analyses (PRISMA) or the consolidated standards of reporting trials (CONSORT) guidelines depending on the study design could improve the quality of the publications. Moreover, there is room for improvement when reporting studies of both OMA and/or RME treatments for managing OSA in children and young adolescents through standardized data reporting. This will enhance the comparability of studies based on identical outcome measures, which will help to establish guidelines for orthodontic treatment of pediatric OSA.”
- Huynh NT, Desplats E, Almeida FR. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: A systematic review and meta-analysis. Sleep Med Rev. 2016 Feb;25:84-94. doi: 10.1016/j.smrv.2015.02.002. Epub 2015 Feb 17. PMID: 26164371.