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The effects of mandibular advancement devices on pediatric obstructive sleep apnea: An umbrella review

Yaqi Li1, Tingting Zhao2, Lizhuo Lin3

  • 1State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.

Sleep Medicine Reviews
|September 26, 2025
PubMed

Insights

Mandibular advancement devices (MADs) may help children with obstructive sleep apnea (OSA) by reducing breathing pauses. However, current evidence is weak due to low-quality reviews, needing more research for reliable clinical guidance.

Area of Science:

  • Pediatric Sleep Medicine
  • Orthodontics
  • Respiratory Medicine

Background:

  • Pediatric obstructive sleep apnea (PedOSA) is a significant health concern in children.
  • Mandibular advancement devices (MADs) are a potential treatment option for PedOSA.
  • Evidence quality regarding MADs efficacy in PedOSA requires critical evaluation.

Purpose of the Study:

  • To conduct an umbrella review of systematic reviews on MADs for PedOSA.
  • To assess the impact of MADs on the apnea-hypopnea index (AHI) and other outcomes.
  • To evaluate the methodological quality and evidence strength of existing systematic reviews.

Main Methods:

  • Searched six databases for systematic reviews up to June 2025.
  • Included studies with children diagnosed with OSA via polysomnography (PSG) and treated with MADs.
  • Extracted data on AHI, oxygen saturation, and skeletal/dental changes; assessed review quality using AMSTAR 2.

Main Results:

  • MADs demonstrated a reduction in AHI and slight improvement in mandibular position.
  • Significant heterogeneity was noted due to variations in device design, treatment duration, and patient factors.
  • Included systematic reviews had predominantly low or critically low methodological quality, with limited randomized controlled trials.

Conclusions:

  • MADs show potential as an adjunctive therapy for specific PedOSA cases.
  • The low methodological quality of current systematic reviews limits the strength of evidence.
  • High-quality primary studies and systematic reviews are essential to confirm MADs' impact and guide clinical practice.

Keywords:
Mandibular advancement devicesOrthodonticsPediatric obstructive sleep apneaUmbrella review

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