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

Shih-Ying Lin1, Yu-Xuan Su2, Yi-Cheng Wu3

  • 1Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan.

International Journal of Paediatric Dentistry
|November 5, 2019
PubMed

Insights

Surgical interventions are most effective for reducing the apnoea-hypopnea index (AHI) in children with obstructive sleep apnoea (OSA). However, no treatment fully resolved OSA in most cases, highlighting the need for further research.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Otolaryngology

Background:

  • Obstructive sleep apnoea (OSA) is a common condition in children.
  • Adenotonsillar hypertrophy is the primary cause of pediatric OSA.
  • Existing treatment options lack comprehensive comparative effectiveness data.

Purpose of the Study:

  • To conduct a network meta-analysis comparing the effectiveness of various treatments for pediatric OSA.
  • To rank interventions based on their efficacy in improving key OSA metrics.
  • To provide evidence-based guidance for clinical decision-making.

Main Methods:

  • Systematic literature search for pediatric OSA with adenotonsillar hypertrophy up to May 2018.
  • Inclusion of 14 trials with 1064 participants evaluating ten interventions.
  • Frequentist network meta-analysis to compare changes in apnoea-hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO2).

Main Results:

  • Surgical approaches demonstrated the highest effectiveness in reducing AHI compared to no treatment.
  • Rapid maxillary expansion (RME) was found to be effective in improving the lowest SaO2.
  • No interventions showed statistically significant reductions in the oxyhaemoglobin desaturation index (ODI).

Conclusions:

  • While surgical interventions are effective for AHI reduction, complete resolution of OSA was not achieved in most pediatric patients.
  • The findings underscore the complexity of pediatric OSA management and the need for individualized treatment strategies.
  • Further research may be warranted to explore combination therapies or novel interventions for refractory cases.
Abstract

Keywords:
childmeta-analysisobstructive sleep apnoearapid maxillary expansion

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