Management of paediatric obstructive sleep apnoea: A systematic review and network meta‐analysis

Abstract

Background Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. Aim Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta‐analysis. Design Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea‐hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO2). Frequentist approach to network meta‐analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. Results Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta‐analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO2. No comparisons showed statistical significance in reducing ODI. Conclusions Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.

Critical issues concerning biocreative strategy in contemporary temporary skeletal anchorage device orthodontics: A narrative review

“…Going back to the ‘TAKE ACTION’ principles, the importance of orthodontic management of upper airway applies to both growing and non‐growing orthodontic patients 4,11 . In growing patients, the goals of early treatment in BOS include favourable upper airway development by accomplishing a stable tripod relationship between nasomaxillary complex and mandible relative to the cranial base 57 . The combined protocol of the horseshoe‐type maxillary expander and tongue elevator with myofunctional training is an airway‐friendly growth modification treatment for pre‐school and school age groups.…”

Expansión maxilar rápida para pacientes pediátricos con síndrome de apnea obstructiva del sueño.

“…Encontramos seis revisiones sistemáticas [4], [5], [6], [7, [8] [9] que incluyeron 23 estudios primarios [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31]. [32] .…”

Sleep‐disordered breathing and malocclusion in children and adolescents—a systematic review

“…the pharynx related to anatomical morphology, which causes collapse of the upper airway through inspiration during sleep. [7][8][9][10] The increased upper airway resistance and pharyngeal collapse result in airway obstruction and inhibit normal respiration, which result in prolonged partial (hypopnea) or intermittent complete (apnoea) obstruction of airflow. 7,8,11 In adult patients, a hypopnea or apnoea is defined to last ≥10 s.…”

“…11 The diagnosis of OSA is confirmed by an overnight polysomnography (PSG) or polygraphy (PG). 1,6,9,11,[14][15][16] The PSG is the gold standard measuring the electric activity in the brain, eye movement, muscular activity in head and legs, thoracic and abdominal motion, respiratory flow, oxygen saturation, pulse, body position, actigraphy and audio recording (breathing and snoring). 6 During PG, the electric activity in the brain, eye movement, muscular activity in head and legs are not measured-but all other mentioned measurements are included in the PG.…”

“…17 SDB causes interruption of sleep, which can result in daytime sleepiness, irritability, nocturnal enuresis, failure to thrive, learning disabilities and reduced growth. 1,2,4,5,18 The main predisposing factors to SDB in children are adenoid vegetations and/or adenotonsillar hypertrophy 9,11,14,19,20 or craniofacial syndromes in relation to decreased space in the upper airway. 11 Other predisposing factors such as overweight 19 and disturbance of the neuromotor response in the upper airway 21 have been identified.…”