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Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review
Carolina Cozzi-Machado1, Fátima Rosana Albertini2, Silvana Silveira1
1Postgraduate Program in Surgical Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
Insights
Mandibular advancement appliances (MAAs) effectively treat pediatric obstructive sleep apnea (OSA), improving the apnea-hypopnea index. Further randomized studies are needed, but MAAs are a valuable part of multidisciplinary OSA care for children.
Area of Science:
- Pediatric Pulmonology
- Orthodontics
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) affects 1.2%–5.7% of children, impacting cognitive, metabolic, and cardiovascular health.
- Current OSA treatments in children include surgery, therapy, and devices, but optimal choices remain debated.
Purpose of the Study:
- To evaluate the efficacy of mandibular advancement appliances (MAAs) for treating pediatric obstructive sleep apnea (OSA).
Main Methods:
- An umbrella review of systematic reviews and meta-analyses was conducted in August 2021.
- Searches were performed across multiple major electronic databases.
Main Results:
- Included studies consistently demonstrated improvements in the apnea-hypopnea index (AHI) following MAA treatment.
- Three systematic reviews and two meta-analyses were synthesized.
Conclusions:
- Mandibular advancement appliances (MAAs) show promise as a component of pediatric OSA management.
- While more randomized controlled trials are recommended, MAAs are a viable option in a multidisciplinary approach for treating childhood OSA.
Abstract:
Introduction Obstructive sleep apnea (OSA) is defined as intermittent partial or complete collapse of the upper airway during sleep. It is a common condition in childhood, with an incidence ranging from 1.2% to 5.7%, and it can harm several aspects of children's life, such as cognitive, metabolic and cardiovascular functions, among others. There are treatment options, such as adenotonsillectomy, myofunctional therapy, mandibular advancement appliances (MAAs), rapid maxillary expansion, and positive airway pressure devices, but there is still doubt about which method is more suitable for the treatment of OSA in children. Objective To analyze the effectiveness of MAAs in the treatment of pediatric OSA. Materials and Methods The search was conducted in August 2021 in different electronic databases, such as PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS, Ovid, SciELO, Web of Science, EMBASE BIREME, BBO BIREME, and the Cochrane Library. Results Only three systematic reviews and two meta-analyses were included in the present study. All studies showed improvement in the score on the apnea-hypopnea index after using MAAs in the treatment of pediatric OSA. Conclusion Although more randomized studies are needed, based on the present umbrella review, MAAs must be considered part of the multidisciplinary treatment for pediatric OSA.
