Mandibular advancement appliances for the treatment of paediatric obstructive sleep apnea: a systematic review

Nazarali, Natasha; Altalibi, Mostafa; Nazarali, Samir; Major, Michael P.; Flores-Mir, Carlos; Major, Paul W.

doi:10.1093/ejo/cju101

Cited by 46 publications

(58 citation statements)

References 82 publications

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“…& Mandibular advancement appliances improve AHI and nadir oxygen saturation, but long-term efficacy has not been established [32,33]. & Maxillomandibular advancement, while rarely performed in children, is a surgical option for adolescents with severe OSA and craniofacial anomalies such as micrognathia [34].…”

Section: Orthodontic Treatmentmentioning

confidence: 99%

“…Mandibular advancement appliances (MAA) can increase the lateral dimension of the velopharyngeal airway as a result of forward positioning of the mandible and also reduce collapsibility of the airway. A recent systematic review of MMA use in children with OSA demonstrated improvements in AHI but failure to normalize PSG parameters [32]. The studies regarding MMA feature small sample sizes and lack of control groups.…”

Section: Mandibular Advancement Appliancesmentioning

confidence: 99%

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An Update on the Management of Pediatric Obstructive Sleep Apnea

Rubinstein

Baldassari

2015

Curr Treat Options Peds

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Section: Orthodontic Treatmentmentioning

confidence: 99%

Section: Mandibular Advancement Appliancesmentioning

confidence: 99%

An Update on the Management of Pediatric Obstructive Sleep Apnea

Rubinstein

Baldassari

2015

Curr Treat Options Peds

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“…Thirteen reviews were on adult OSA (2 SRs and 11 SRs with MAs), 1,[49][50][51][52][53][54][55][56][57][58][59][60] and four reviews were on pediatric OSA (3 SRs and 1 SR with MA). 12,15,61,62 Key methodological and descriptive characteristics of the included reviews are presented in Tables 2 and 3.…”

Section: R Esu Lt Smentioning

confidence: 99%

“…With respect to the pediatric OSA reviews, the comparison groups included no treatment, placebo, and pretreatment and posttreatment with only one OA type. Two reviews 12,62 included studies on maxillary expansion with and without concurrent use of fixed orthodontic appliances. Another review 15 included five RCTs that assessed seven independent interventions with only one of those targeting OAs.…”

Section: R Esu Lt Smentioning

confidence: 99%

“…Lie et al 56 had the highest quality among all the reviews (11/11) and Iftikhar et al's 58 review had the lowest (5/11). Of the reviews on pediatric OSA, three were of high quality 15,61,62 and one was medium quality 12 and the total mean score for the studies was 9 ± 1.41 and the range was 7 to 10. Kuhle et al 15 and Carvalho et al 61 both had the highest score, whereas Huynh et al 12 had the lowest score.…”

Section: R Esu Lt Smentioning

confidence: 99%

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Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

Al-Jewair

Gaffar

Flores-Mir

2016

Journal of Clinical Sleep Medicine

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Study Objectives: To assess the methodological quality of published systematic reviews (SRs) and meta-analyses (MAs) about the efficacy of oral appliances (OA) in the management of adult and pediatric sleep-disordered breathing (SDB). Methods: SRs/MAs that evaluated the efficacy of OA therapy on the treatment of SDB in human subjects of all age groups were sought. Multiple electronic databases were searched for articles published in any language from the database's inception until January 2016. Two reviewers independently selected and then assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool. Results: Thirteen reviews on adult SDB were included (2 SRs and 11 SRs with MAs). Of those, seven were medium quality and six were high quality. Only four reviews were included on pediatric SDB (3 SRs and 1 SR with MA). Three of these were of high quality and one was medium quality. The identified limitations in the included reviews were failing to reference the excluded studies or describe reasons for exclusion, lack of applying valid criteria to assess the quality of included studies, lack of publication bias assessment, and absence of conflicts of interest reporting. Conclusions: Overall, SRs/MAs on OA therapy for adult and pediatric SDB were conducted with acceptable methodological quality. High AMSTAR scores should not be extrapolated as a proxy of the methodological quality of the included evidence. There is a need for more primary studies and then that information can be used to be synthesized through SRs on pediatric SDB. Keywords: mandibular advancement device, sleep apnea syndrome, systematic review, treatment efficacy Citation: Al-Jewair TS, Gaffar BO, Flores-Mir C. Quality assessment of systematic reviews on the efficacy of oral appliance therapy for adult and pediatric sleep-disordered breathing. J Clin Sleep Med 2016;12(8):1175-1183. I NTRO DUCTI O NLoud snoring and obstructive sleep apnea (OSA) are common sleep-disordered breathing (SDB) conditions that can affect growing and nongrowing individuals. OSA is characterized by repetitive partial (hypopnea) or complete (apnea) upper airway obstructions lasting at least 10 sec and by snoring during sleep.1 The prevalence in adults ranges from 9% to 24% for OSA and from 2% to 4% for OSA when daytime symptoms are considered.2 SDB/OSA occurs in 1.2% to 5.8% of children and adolescents. 3,4 Multiple factors had been identified in the etiology of SDB/ OSA. These included structural constrictions of the soft tissue space surrounding the oropharynx and nasopharynx and its lumen (i.e., hypertrophied tonsils and/or adenoids), 1 constrictions surrounding the nasal cavity, 5 neuromuscular abnormalities of the upper airway, 1 hyperdivergent craniofacial growth patterns, 6 genetic markers (i.e., tumor necrosis factor-alpha), 7 early life programming 8 (i.e., exposure to secondhand cigarette smoking and poor nutrition), and prenatal factors such as hormonal and physiological changes during gestation, 9 i...

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Sleep Disordered Breathing in Children

Perez¹

2021

Handbook of Clinical Techniques in Pediatric Dentistry

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Mandibular advancement appliances for the treatment of paediatric obstructive sleep apnea: a systematic review

Abstract: The current limited evidence may be suggestive that MAAs result in short-term improvements in AHI scores, but it is not possible to conclude that MMAs are effective to treat pediatric OSA. Medium- and long-term assessments are still required.

Cited by 46 publications

References 82 publications

An Update on the Management of Pediatric Obstructive Sleep Apnea

An Update on the Management of Pediatric Obstructive Sleep Apnea

Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

Sleep Disordered Breathing in Children

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