Treatment Strategies for Craniofacial Microsomia Patients With Obstructive Sleep Apnea: A Systematic Review

This systematic review aims to evaluate the efficacy of various treatment strategies for obstructive sleep apnea (OSA) in patients with craniofacial microsomia (CFM).

A comprehensive search was conducted in PubMed, Embase, Medline, Cochrane Library, and Web of Science databases up to April 14, 2024. Data were extracted on patient demographics, severity classification, treatment techniques, and outcomes based on polysomnography evaluations and other evaluation metrics. The quality of evidence for each study was assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) criteria. This review followed the PRISMA guidelines to ensure comprehensive and systematic reporting.

A total of 36 studies were included, involving 405 patients with CFM and OSA. Nonsurgical treatments such as continuous positive airway pressure showed significant reductions in apnea-hypopnea index (AHI) and improvements in oxygen saturation. Surgical interventions, including mandibular distraction osteogenesis and adenotonsillectomy, demonstrated marked improvements in polysomnography parameters. Post-treatment, SpO2 increased from below 76% to above 95%, while AHI/respiratory disturbance index decreased to <2 per hour. The total effective rate for mandibular distraction osteogenesis ranged up to 60%, with significant reductions in obstructive AHI and improvements in LSaO2.

While current treatment strategies show promise in managing OSA in CFM patients, the variability in craniofacial deformities and the multifactorial nature of OSA necessitate personalized treatment plans. Further research is needed to establish comprehensive guidelines and optimize outcomes for this patient population.