Abstract
Abstract Aim To evaluate the effect of the cervical headgear on the development of obstructive sleep apnoea and subsequent alterations of oropharyngeal dimensions. Materials and method An electronic database search of published and unpublished literature was performed (MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Clinical Trials.gov and National Research Register). Search terms included obstructive sleep apnoea, sleep disorders, pharyngeal dimensions and headgear. A risk of bias assessment was conducted using the ACROBAT-NRSI tool for non-randomised studies. Results Of the 51 articles initially retrieved, only three were eligible for inclusion, while the remainder were retrospective cohort studies presenting serious risk of bias primarily due to undetected confounding factors or selection bias. No quantitative synthesis was possible. One study assessed the potential effect of isolated headgear treatment on apnoeic indices, while two studies described pharyngeal airway dimensions after the use of headgear alone or in combination with an activator appliance. Overall, increased apnoeic indices and the oxygen desaturation index were detected for headgear users. Dimensional changes in the posterior airway space were comparable after headgear or activator use, while combined headgear-activator treatment led to an increase in posterior pharyngeal area when compared with isolated fixed appliance therapy. Conclusions Due to methodological inconsistencies and apparent risk of bias of the existing studies, no robust conclusions can be drawn. Prospective controlled or randomised controlled trials are deemed necessary to provide evidence on the effect of headgear treatment on sleep apnoea or pharyngeal airway dimensions.
Highlights
Obstructive sleep apnoea syndrome (OSAS) is common and aligns within the sleep disordered breathing (SDB) spectrum
A total of six studies[24,33,34,35,36,37] were left for full text evaluation and potential inclusion in the review. Three of these studies were rejected after full text screening, due to an absence of comparator groups or irrelevant outcomes in relation to the formulated question of the present review
The combined use of an activator-headgear appliance revealed increases in pharyngeal airway parameters related to area, length and the smallest distance between the tongue and the posterior pharyngeal wall after the active phase of treatment
Summary
Obstructive sleep apnoea syndrome (OSAS) is common and aligns within the sleep disordered breathing (SDB) spectrum. It is characterised by repetitive episodes of complete respiratory upper airway obstruction during sleep, which is associated with a reduction in blood oxygen saturation, loud snoring, sleep arousal or awakenings, a cessation of breathing and, in severe cases, cyanosis.[1] Upon awakening, patients typically feel wearied and may Australasian Orthodontic Journal Volume 34 No 2 November 2018. It has been claimed that individuals with OSAS may demonstrate maxillary and mandibular retrognathism, larger craniocervical angles, reduced upper airway space, a longer and thicker palate and a low hyoid bone position.[11,12,13,14] no causal relationship between these craniofacial characteristics and obstruction of pharyngeal airway has yet been established.[15]
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