Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta‐analysis

Camacho, Macario; Chang, Edward T.; Song, Sungjin A.; Abdullatif, José; Zaghi, Soroush; Pirelli, P; Certal, Victor; Guilleminault, Christian

doi:10.1002/lary.26352

Cited by 159 publications

(98 citation statements)

References 40 publications

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“…The obvious theoretical advantages of such intervention are to reduce or compete eradicate residual OSA in children. However, the cumulative evidence to date on RME experience in the setting of residual OSA consists of small uncontrolled studies with a relatively short follow-up period [119][120][121][122][123][124]. Overall, it would appear that RME may have a role in carefully selected patients, more specifically in those presenting obvious malocclusion (i.e., high, narrow palate associated with deep bite, retrusive bite or crossbite) and OSA [125,126].…”

Section: Rapid Maxillary Expansionmentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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Section: Rapid Maxillary Expansionmentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

View full text Add to dashboard Cite

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“…These authors also reported that the predisposition of these patients to this disorder would be related to genetic factors that would result in alterations in craniofacial growth or secondary alterations of the growth pattern in response to adenotonsillar hypertrophy. It is worth emphasizing the need for randomized studies to evaluate the long-term effects of treatments on the improvement of AHI levels as well as oxyhemoglobin saturation, considering the effect of infant growth, as well as the spontaneous resolution of the disease [15].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Obstructive Sleep Apnea Syndrome - Mini Review

Guimarães¹,

Simamotto²,

Cunha³

et al. 2017

JDHODT

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“…They also noted that the AHI improved more in children with previous adenotonsillectomy or with small tonsils. 33 In another study published by Pirelli et al, 31 pediatric patients with OSA experienced normalization of their AHI after a mean cross-sectional expansion of the maxilla of 4.32 ± 0.7 mm. 31 In a follow-up study of these same patients 12 years later, 23 of them demonstrated maintenance and stability of the expansion and no recurrence of OSA.…”

mentioning

confidence: 94%

Anatomy of Obstructive Sleep Apnea: An Evolutionary and Developmental Perspective

Torre¹,

Ramos²,

Dib³

et al. 2014

International Journal of Head and Neck Surgery

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Aim:Our goal was to present obstructive sleep apnea (OSA) from evolutionary and developmental perspective by highlighting the different elements that predispose humans to develop this condition. Background: The development of complex speech and bipedalism were some of the adaptations that resulted in changes that predispose humans as a species to the development of OSA. Laryngeal descent and regression of the maxillomandibular complex were some of the changes that took place and that led to a smaller and more collapsible airway. During development, reduction of the posterior airway space and suboptimal growth of the maxillomandibular complex further increase the risk of developing OSA as adults.Review results: Treatment of OSA should be a continuous effort that starts early in childhood through the establishment of adequate nasal breathing. Chronic mouth breathing during active craniofacial development of a child may result in anatomical changes that directly affect the airway. Different strategies may be applied to optimize nasal breathing and that allow continuous interaction between the nasomaxillary complex and the mandible during development. Ultimately, this will guide the growth of the entire facial-skeletal complex in a forward and horizontal orientation. This will result in a lower risk of developing a narrow and collapsible airway later in life. Conclusion: Treatment of OSA should be a continuous effort to establish adequate nasal breathing early in life that will maximize the growth and development of the facial-skeletal complex and the upper airway. In order to accomplish this, multiple strategies need to be considered and possibly combined. Clinical significance: OSA is a common disorder characterized by repetitive upper airway narrowing during sleep with resulting hypoxemia, hypercapnia, sympathetic activation, and sleep disruption. Early intervention in children suspected to have OSA is essential to reduce the risk of developing more severe OSA as adults.

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Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta‐analysis

Cited by 159 publications

References 40 publications

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Pediatric Obstructive Sleep Apnea Syndrome - Mini Review

Anatomy of Obstructive Sleep Apnea: An Evolutionary and Developmental Perspective

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