Sleep Medicine

Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis

Corresponding Author

Macario Camacho MD

[email protected]

Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, California, U.S.A.

Send correspondence to Macario Camacho, MD, Tripler Army Medical Center, Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Jarrett White Road, Tripler AMC, HI 96859. E-mail: [email protected]Search for more papers by this author

Edward T. Chang MD, MS,

Edward T. Chang MD, MS

Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

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Sungjin A. Song MD,

Sungjin A. Song MD

Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

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Jose Abdullatif MD,

Jose Abdullatif MD

Sleep Surgery Department, Instituto Ferrero de Neurología y Sueño, Buenos Aires, Argentina

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Soroush Zaghi MD,

Soroush Zaghi MD

Division of Sleep Surgery and Medicine, Department of Otolaryngology–Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A.

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Paola Pirelli DDS,

Paola Pirelli DDS

Department of Clinical Sciences and Translational Medicine, University of Rome, Rome, Tor Vergata, Italy

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Victor Certal MD, PhD,

Victor Certal MD, PhD

Department of Otorhinolaryngology/Sleep Medicine Center, , Companhia União Fabril & Centro Hospitalar Entre Douro e Vouga Hospital, Porto, Portugal

Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal

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Christian Guilleminault MD,

Christian Guilleminault MD

Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, California, U.S.A.

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Macario Camacho MD,

Corresponding Author

Macario Camacho MD

[email protected]

Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, California, U.S.A.

Edward T. Chang MD, MS,

Edward T. Chang MD, MS

Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

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Sungjin A. Song MD,

Sungjin A. Song MD

Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

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Jose Abdullatif MD,

Jose Abdullatif MD

Sleep Surgery Department, Instituto Ferrero de Neurología y Sueño, Buenos Aires, Argentina

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Soroush Zaghi MD,

Soroush Zaghi MD

Division of Sleep Surgery and Medicine, Department of Otolaryngology–Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A.

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Paola Pirelli DDS,

Paola Pirelli DDS

Department of Clinical Sciences and Translational Medicine, University of Rome, Rome, Tor Vergata, Italy

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Victor Certal MD, PhD,

Victor Certal MD, PhD

Department of Otorhinolaryngology/Sleep Medicine Center, , Companhia União Fabril & Centro Hospitalar Entre Douro e Vouga Hospital, Porto, Portugal

Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal

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Christian Guilleminault MD,

Christian Guilleminault MD

Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, California, U.S.A.

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First published: 31 October 2016

https://doi.org/10.1002/lary.26352

Citations: 164

Institution where the work was primarily performed: Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objectives/Hypothesis

To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA).

Data Sources

PubMed/MEDLINE and eight additional databases.

Review Methods

Three authors independently and systematically reviewed the international literature through February 21, 2016.

Results

Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea–hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is −1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73–95% reduction) than in children with large tonsils (61% reduction). For >3-year follow-up (range = 6.5–12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction).

Conclusions

Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up). Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope, 2016 Laryngoscope, 127:1712–1719, 2017

Supporting Information

BIBLIOGRAPHY

1 Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1: 862–865.
10.1016/S0140-6736(81)92140-1
CAS PubMed Web of Science® Google Scholar
2 Sutherland K, Vanderveken OM, Tsuda H, et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med 2014; 10: 215–227.
10.5664/jcsm.3460
PubMed Web of Science® Google Scholar
3 Camacho M, Certal V, Abdullatif J, et al. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep 2015; 38: 669–675.
10.5665/sleep.4652
PubMed Web of Science® Google Scholar
4 Camacho M, Certal V, Capasso R. Comprehensive review of surgeries for obstructive sleep apnea syndrome. Braz J Otorhinolaryngol 2013; 79: 780–788.
10.5935/1808-8694.20130139
PubMed Web of Science® Google Scholar
5 Holty JE, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev 2010; 14: 287–297.
10.1016/j.smrv.2009.11.003
PubMed Web of Science® Google Scholar
6 Camacho M, Li D, Kawai M, et al. Tonsillectomy for adult obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2016; 126: 2176–2186.
10.1002/lary.25931
PubMed Web of Science® Google Scholar
7 Certal VF, Zaghi S, Riaz M, et al. Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2015; 125: 1254–1264.
10.1002/lary.25032
PubMed Web of Science® Google Scholar
8 Camacho M, Certal V, Brietzke SE, Holty JE, Guilleminault C, Capasso R. Tracheostomy as treatment for adult obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2014; 124: 803–811.
10.1002/lary.24433
CAS PubMed Web of Science® Google Scholar
9 Pirelli P, Saponara M, De Rosa C, Fanucci E. Orthodontics and obstructive sleep apnea in children. Med Clin North Am 2010; 94: 517–529.
10.1016/j.mcna.2010.02.004
PubMed Web of Science® Google Scholar
10 Abdullatif J, Certal V, Zaghi S, et al. Maxillary expansion and maxillomandibular expansion for adult OSA: a systematic review and meta-analysis. J Craniomaxillofac Surg 2016; 44: 574–578.
10.1016/j.jcms.2016.02.001
PubMed Web of Science® Google Scholar
11 Huynh NT, Desplats E, Almeida FR. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis. Sleep Med Rev 2016; 25: 84–94.
10.1016/j.smrv.2015.02.002
PubMed Web of Science® Google Scholar
12 Vidya V, Sumathi F. Rapid maxillary expansion as a standard treatment for obstructive sleep apnea syndrome: a systematic review. J Dental Med Sci 2015; 14: 51–55.
Google Scholar
13 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097.
10.1371/journal.pmed.1000097
PubMed Web of Science® Google Scholar
14 Methods for Development of NICE Public Health Guidance. London, UK: National Institute for Health and Clinical Excellence; 2009.
Google Scholar
15 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Erlbaum; 1988.
10.1046/j.1526-4610.2001.111006343.x
Google Scholar
16 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.
10.1002/sim.1186
PubMed Google Scholar
17 Lau J, Ioannidis JP, Schmid CH. Quantitative synthesis in systematic reviews. Ann Intern Med 1997; 127: 820–826.
10.7326/0003-4819-127-9-199711010-00008
CAS PubMed Web of Science® Google Scholar
18 Villa MP, Rizzoli A, Rabasco J, et al. Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children. Sleep Med 2015; 16: 709–716.
10.1016/j.sleep.2014.11.019
PubMed Web of Science® Google Scholar
19 Caprioglio A, Meneghel M, Fastuca R, Zecca PA, Nucera R, Nosetti L. Rapid maxillary expansion in growing patients: correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol 2014; 78: 23–27.
10.1016/j.ijporl.2013.10.011
PubMed Web of Science® Google Scholar
20 Villa MP, Miano S, Rizzoli A. Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome. Sleep Breath 2012; 16: 971–976.
10.1007/s11325-011-0595-9
PubMed Web of Science® Google Scholar
21 Guilleminault C, Quo S, Huynh NT, Li K. Orthodontic expansion treatment and adenotonsillectomy in the treatment of obstructive sleep apnea in prepubertal children. Sleep 2008; 31: 953–957.
PubMed Web of Science® Google Scholar
22 Pirelli P, Saponara M, Attanasio G. Obstructive sleep apnoea syndrome (OSAS) and rhino-tubaric disfunction in children: therapeutic effects of RME therapy. Prog Orthod 2005; 6: 48–61.
PubMed Google Scholar
23 Guilleminault C, Lee JH, Chan A. Pediatric obstructive sleep apnea syndrome. Arch Pediatr Adolesc Med 2005; 159: 775–785.
10.1001/archpedi.159.8.775
PubMed Web of Science® Google Scholar
24 Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep 2004; 27: 761–766.
10.1093/sleep/27.4.761
PubMed Web of Science® Google Scholar
25 Guilleminault C, Li K, Quo S, Inouye RN. A prospective study on the surgical outcomes of children with sleep-disordered breathing. Sleep 2004; 27: 95–100.
PubMed Web of Science® Google Scholar
26 Villa MP, Sujanska A, Vitelli O, et al. Use of the sleep clinical record in the follow-up of children with obstructive sleep apnea (OSA) after treatment. Sleep Breath 2016; 20: 321–329.
10.1007/s11325-015-1287-7
PubMed Web of Science® Google Scholar
27 Taddei M, Alkhamis N, Tagariello T, D'Alessandro G, Mariucci EM, Piana G. Effects of rapid maxillary expansion and mandibular advancement on upper airways in Marfan's syndrome children: a home sleep study and cephalometric evaluation. Sleep Breath 2015; 19: 1213–1220.
10.1007/s11325-015-1141-y
PubMed Web of Science® Google Scholar
28 Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up. Sleep Med 2015; 16: 933–935.
10.1016/j.sleep.2015.04.012
PubMed Web of Science® Google Scholar
29 Fatsuca R, Perinetti G, Zecca PA, Nucera R, Caprioglio A. Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: a longitudinal correlation study. Angle Orthod 2015; 85: 955–961.
10.2319/072014-504.1
PubMed Web of Science® Google Scholar
30 Villa MP, Castaldo R, Miano S, et al. Adenotonsillectomy and orthodontic therapy in pediatric obstructive sleep apnea. Sleep Breath 2014; 18: 533–539.
10.1007/s11325-013-0915-3
PubMed Web of Science® Google Scholar
31 Kim M. Orthodontic treatment with rapid maxillary expansion for treating a boy with severe obstructive sleep apnea. Sleep Med Res 2014; 5: 33–36.
10.17241/smr.2014.5.1.33
Google Scholar
32 Guilleminault C, Huang YS, Quo S, Monteyrol PJ, Lin CH. Teenage sleep-disordered breathing: recurrence of syndrome. Sleep Med 2013; 14: 37–44.
10.1016/j.sleep.2012.08.010
PubMed Web of Science® Google Scholar
33 Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion before and after adenotonsillectomy in children with obstructive sleep apnea. Somnologie 2012; 16: 125–132.
10.1007/s11818-012-0560-2
Google Scholar
34 Marino A, Ranieri R, Chiarotti F, Villa MP, Malagola C. Rapid maxillary expansion in children with obstructive sleep apnoea syndrome (OSAS). Eur J Paediatr Dent 2012; 13: 57–63.
CAS PubMed Web of Science® Google Scholar
35 Goncalves LPV, Ayrton de Toledo O. Quality of life of children with respiratory disturbances during sleep after rapid maxillary expansion. Doctoral Thesis. University of Brazil. 2012; 1–96.
Google Scholar
36 Villa MP, Rizzoli A, Miano S, Malagola C. Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath 2011; 15: 179–184.
10.1007/s11325-011-0505-1
PubMed Web of Science® Google Scholar
37 Guilleminault C, Monteyrol PJ, Huynh NT, Pirelli P, Quo S, Li K. Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study. Sleep Breath 2011; 15: 173–177.
10.1007/s11325-010-0419-3
PubMed Web of Science® Google Scholar
38 Miano S, Rizzoli A, Evangelisti M, et al. NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome. Sleep Med 2009; 10: 471–478.
10.1016/j.sleep.2008.04.003
PubMed Web of Science® Google Scholar
39 Hosselet J, Phaliah L, Offrer Y, Bearez G. Evaluation of maxillary expansion for the treatment of sleep-disordered breathing in children. Am J Respir Crit Care Med 179;2009: A1748.
Web of Science® Google Scholar
40 Villa MP, Malagola C, Pagani J, et al. Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. Sleep Med 2007; 8: 128–134.
10.1016/j.sleep.2006.06.009
PubMed Web of Science® Google Scholar
41 Rose E, Schessl J. Orthodontic procedures in the treatment of obstructive sleep apnea in children. J Orofac Orthop 2006; 67: 58–67.
10.1007/s00056-006-0534-8
PubMed Google Scholar
42 Torre C, Camacho M, Liu SY, Huon LK, Capasso R. Epiglottis collapse in adult obstructive sleep apnea: a systematic review. Laryngoscope 2016; 126: 515–523.
10.1002/lary.25589
PubMed Web of Science® Google Scholar
43 Camacho M, Dunn B, Torre C, et al. Supraglottoplasty for laryngomalacia with obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2016; 126: 1246–1255.
10.1002/lary.25827
PubMed Web of Science® Google Scholar
44 Schuster G, Borel-Scherf I, Schopf PM. Frequency of and complications in the use of RPE appliances—results of a survey in the Federal State of Hesse, Germany. J Orofac Orthop 2005; 66: 148–161.
10.1007/s00056-005-0431-6
PubMed Google Scholar

Citing Literature

Volume127, Issue7

July 2017

Pages 1712-1719

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lary26352-sup-0001-suppnf1.docx10 KB	Supporting Figure Caption
lary26352-sup-0002-suppf2.tif66.9 KB	Supporting Figure 1
lary26352-sup-0002-suppf3.tif21.2 KB	Supporting Figure 2

Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis

Abstract

Objectives/Hypothesis

Data Sources

Review Methods

Results

Conclusions

Supporting Information

BIBLIOGRAPHY

Citing Literature

References

Information

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Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis

Abstract

Objectives/Hypothesis

Data Sources

Review Methods

Results

Conclusions

Supporting Information

BIBLIOGRAPHY

Citing Literature

References

Related

Information