Efficacy of Rapid Maxillary Expansion with or without Previous Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome Based on Polysomnographic Data: A Systematic Review and Meta-Analysis

Vincenzo Quinzi,Sabina Saccomanno,Giuseppe Marzo,Licia Coceani Paskay,Rebecca Jewel Manenti,Silvia Giancaspro

doi:10.3390/app10186485

Vincenzo Quinzi, Sabina Saccomanno + Show 4 more

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https://doi.org/10.3390/app10186485

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Journal: Applied sciences	Publication Date: Sep 17, 2020
Citations: 16	License type: CC BY 4.0

Affiliation: University of L'Aquila

Abstract

Aim: To systematically review international literature related to rapid maxillary expansion (RME) as the treatment for obstructive sleep apnea syndrome (OSAS) in children less than 18 years-old, followed by a meta-analysis of the apnea-hypopnea index (AHI) before and after RME, with or without a previous adenotonsillectomy (AT). Methods: Literature on databases from PubMed, Wiley online library, Cochrane Clinical Trials Register, Springer link, and Science Direct were analyzed up to March 2020. Two independent reviewers (S.G. and R.J.M.) screened, assessed, and extracted the quality of the publications. A meta-analysis was performed to compare AHI values before and after the treatment with RME. Results: Six studies reported outcomes for 102 children with a narrow maxillary arch suffering from OSAS with a mean age of 6.7 ± 1.3. AHI improved from a M ± SD of 7.5 ± 3.2/h to 2.5 ± 2.6/h. A higher AHI change in patients with no tonsils (83.4%) and small tonsils (97.7%) was detected when compared to children with large tonsils (56.4%). Data was analyzed based on a follow-up duration of ≤3 year in 79 children and >3 years in 23 children. Conclusion: Reduction in the AHI was detected in all 102 children with OSAS that underwent RME treatment, with or without an adenotonsillectomy. Additionally, a larger reduction in the AHI was observed in children with small tonsils or no tonsils. A general improvement on the daytime and nighttime symptoms of OSAS after RME therapy was noted in all the studies, demonstrating the efficacy of this therapy.

Highlights

Obstructive sleep apnea syndrome (OSAS) is defined as the extreme end of the spectrum of obstructive sleep disordered breathing in children with a protracted partial upper airway obstruction and/or an intermittent complete obstruction [1,2]
Related to the primary outcome, the apnea-hypopnea index (AHI) in 102 children with a mean age of 6.7 ± 1.3 with obstructive sleep apnea decreased after rapid maxillary expansion (RME) treatment
A larger AHI reduction was observed in children with small tonsils (97.7%) or no tonsils (82.4%) rather than large tonsils

Summary

Introduction

Obstructive sleep apnea syndrome (OSAS) is defined as the extreme end of the spectrum of obstructive sleep disordered breathing in children with a protracted partial upper airway obstruction (hypopnea) and/or an intermittent complete obstruction (apnea) [1,2]. This disorder presents repeated events of partial and complete airway obstruction during sleep that brings to a disruption of normal ventilation, decrease in oxygen saturation, arousals and more severe impairments in cognitive function [1,3].

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