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Published on: December 6, 2016
Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children
F R Carvalho1, D Lentini-Oliveira, M A C Machado
1Universidade Federal de São Paulo, Internal Medicine Department, Rua Padre Damaso, 314, Osasco, Centro, Brazil, 06016-010. frcarv@bn.com.br
Insights
Oral appliances may help children with craniofacial anomalies and sleep apnea. However, current evidence is insufficient to confirm their effectiveness for treating obstructive sleep apnea syndrome (OSAS) in all children.
Area of Science:
- Pediatric Sleep Medicine
- Orthodontics
- Respiratory Medicine
Background:
- Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in children.
- Risk factors include adenotonsillar hypertrophy, obesity, and craniofacial anomalies.
- Adenotonsillectomy is the primary treatment, but carries surgical risks and potential recurrence.
Purpose of the Study:
- To evaluate the effectiveness of oral appliances or functional orthopaedic appliances for treating OSAS in children.
- To assess their impact on respiratory function and related parameters.
Main Methods:
- A systematic review of randomized or quasi-randomised controlled trials was conducted.
- Searches included multiple databases (CENTRAL, PubMed, EMBASE, Lilacs, BBO, SciELO) with no language restrictions.
- Studies compared oral/functional orthopaedic appliances to placebo or no treatment in children up to 15 years old.
Main Results:
- Only one trial, involving 23 patients, met the inclusion criteria.
- The available data partially addressed the review questions, with presented results favoring treatment.
- Further data was needed to fully answer all review questions.
Conclusions:
- Insufficient evidence currently supports the general effectiveness of oral appliances for OSAS in children.
- These appliances may offer benefits for children with craniofacial anomalies that contribute to apnea.
Background:
Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adenotonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they change the mandible posture forwards and potentially enlarge the upper airway and increase the upper airspace, improving the respiratory function.
Objectives:
To assess the effectiveness of oral appliances or functional orthopaedic appliances for OSAS in children.
Search Strategy:
A sensitive search was developed for the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); PubMed (January 1966 to September 2005); EMBASE (1980 to September 2005); Lilacs (1982 to September 2005); BBO-Bibliografia Brasileira de Odontologia (1986 to September 2005); and SciELO (1997 to September 2005). There was no restriction of language or source of information.
Selection Criteria:
All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger.
Primary Outcome:
reduction of apnoea to less than one episode per hour.
Secondary Outcomes:
dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiologic function, behavioural problems, drop outs and withdrawals, quality of life, side effects (tolerability), economic evaluation.
Data Collection And Analysis:
Data were independently extracted by two review authors. Authors were contacted for additional information. Risk ratios with 95% confidence intervals were calculated for all important dichotomous outcomes.
Main Results:
The initial search identified 384 trials. One of them, reporting results from a total of 23 patients, was suitable for inclusion in the review. Data provided in the published report did not answer all the questions from this review, but some of them were, and the presented results favour treatment.
Authors' Conclusions:
At present there is no sufficient evidence to state that oral appliances or functional orthopaedic appliances are effective in the treatment of OSAS in children. Oral appliances or functional orthopaedic appliances may be helpful in the treatment of children with craniofacial anomalies which are risk factors for apnoea.
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