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Cited by 127Obstructive Sleep Apnea ResearchOrthodontics and Dentofacial OrthopedicsTemporomandibular Joint Disorders

Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children

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Carvalho, Fernando R, Lentini-Oliveira, Débora A, Prado, Lucila BF, Prado, Gilmar F, Carvalho, Luciane BC·2016·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd005520.pub3PMC PMC6458031
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Abstract

BACKGROUND: Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adeno-tonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbidities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they hold the lower jaw (mandible) forwards which potentially enlarges the upper airway and increases the upper airspace, improving the respiratory function. OBJECTIVES: To assess the effects of oral appliances or functional orthopaedic appliances for obstructive sleep apnoea in children. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 7 April 2016); Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3) in the Cochrane Library (searched 7 April 2016); MEDLINE Ovid (1946 to 7 April 2016); Embase Ovid (1980 to 7 April 2016); LILACS BIREME (from 1982 to 7 April 2016); BBO BIREME (from 1986 to 7 April 2016) and SciELO Web of Science (from 1997 to 7 April 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials on 7 April 2016. We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger. PRIMARY OUTCOME: reduction of apnoea to less than one episode per hour. SECONDARY OUTCOMES: dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiological function, behavioural problems, quality of life, side effects (tolerability) and economic evaluation. DATA COLLECTION AND ANALYSIS: Two review authors screened studies and extracted data independently. Authors were contacted for additional information. We calculated risk ratios with 95% confidence intervals for all important dichotomous outcomes. We assessed the quality of the evidence of included studies using GRADEpro software. MAIN RESULTS: The initial search identified 686 trials. Only one trial, reporting the results from a total of 23 children and comparing an oral appliance to no treatment, was suitable for inclusion in the review. The trial assessed apnoea-hypopnoea, daytime symptoms (sleepiness, irritability, tiredness, school problems, morning headache, thirstiness in the morning, oral breathing and nasal stuffiness) and night-time symptoms (habitual snoring, restless sleep and nightmares measured by questionnaire). Results were inconsistent across outcomes measures and time points. The evidence was considered very low quality. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the effectiveness of oral appliances and functional orthopaedic appliances for the treatment of obstructive sleep apnoea in children. Oral appliances or functional orthopaedic appliances may be considered in specified cases as an auxiliary in the treatment of children who have craniofacial anomalies which are risk factors for apnoea.

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Crossref · 10.1002/14651858.cd005520.pub3

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97 of 97 references verified0 citation errors · 0 not checkable

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  • Evidence from a 2016 Cochrane systematic review was insufficient for the effectiveness of oral appliances (OAs) in treating pediatric OSA.

    “A 2016 Cochrane systematic review compared the course of OSA in children following the use of personalized OAs versus no intervention; however, evidence of OA for treating OSA was insufficient [8].”

    From Airway morphology, hyoid position, and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances (2025) · cites this paper as [8]

  • In three included studies, Yanyan et al., Carvalho et al., and Huynh et al., a reduction of at least 50% in the apnea-hypopnea index was observed after mandibular advancement appliance treatment, and this was considered therapeutic success.

    “In the other 3 studies, 17 20 21 a reduction of at least 50% in the AHI was observed, which was considered as therapeutic success, even if the scores were not within the normal range.”

    From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [20]

  • A significant number of children do not respond to adenotonsillectomy, and most of them do not tolerate continuous positive airway pressure therapy.

    “A significant number of children do not respond to adenotonsillectomy, which is still the primary treatment for OSA, and most of them do not tolerate CPAP therapy.”

    From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [20]

  • Functional orthopedic appliances, if correctly prescribed, are well tolerated and are able to increase airway space during sleep, reduce airway collapsibility, and improve muscle tone.

    “Therefore, functional orthopedic appliances, if correctly prescribed, are well tolerated and are able to increase airway space during sleep, reduce airway collapsibility, and improve muscle tone. 18 20”

    From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [20]

  • Many adults begin snoring and experiencing other respiratory disturbances, such as obstructive sleep apnea, in childhood, so early diagnosis and treatment are relevant to prevent long-term complications in adult life.

    “Many adults begin snoring and experiencing other respiratory disturbances, such as OSA, in childhood; hence, the relevance of early diagnosis and treatment to prevent long-term complications in adult life. These measures also contribute to reduce costs to the healthcare system and improve quality of life. 20”

    From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [20]

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1 retracted

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4 of the 101 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Bell RB, Turvey TA. Skeletal advancement for the treatment of obstructive sleep apnea. The Cle Palate-Craniofacial Journal 2001;38(2):147-54.
  2. Nixon GM, Brouillette RT. Sleep. 8: Paediatric obstructive sleep apnoea. Thorax 2005;60(6):511-6. [MEDLINE: 15923253]
  3. "upper airway resistance" or "sleep disordered breathing" or snor$).ti,ab. 17. or/13-16 18. 12 and 17 The above subject search was linked to the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomised trials in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 6.4.11.1 and detailed in box 6.4.c of theCochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011) (Higgins 2011).
  4. "upper airway resistance" or "sleep disordered breathing" or snor$).ti,ab. 17. or/13-16 18. 12 and 17 The above subject search was linked to adapted version of the Cochrane Embase Project filter for identifying RCTs in Embase via Ovid (see http://www.cochranelibrary.com/help/central-creation-details.html for information):

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Authors
Carvalho, F. R., Lentini-Oliveira, D. A., Prado, L. B., Prado, G. F., & Carvalho, L. B.
Affiliations
  • Universidade Federal de São Paulo (BR)
  • Universidade Federal de São Paulo; Department of Neurology; Rua Claudio Rossi,394 São Paulo São Paulo Brazil 01547-000
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2016-10-04
Volume
2016
Issue
11
Pages
CD005520-CD005520
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd005520.pub3
PMC
PMC6458031
OpenAlex
W1572240561
Cited by
127
References
101
Citations by year
2025: 8 · 2024: 7 · 2023: 8 · 2022: 13 · 2021: 13 · 2020: 3 · 2019: 13 · 2018: 8 · 2017: 5 · 2016: 10 · 2015: 7 · 2014: 6 · 2013: 2 · 2012: 5
FWCI
1.41
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
  • Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
Keywords
obstructive sleep apnea, children, oral appliances, mandibular advancement, craniofacial anomalies, adenotonsillar hypertrophy, sleep parameters, cognitive function, behavioral problems, quality of life, treatment tolerability, economic evaluation, conservative treatment, adenotonsillectomy
MeSH terms
Adolescent, Child, Humans, Orthodontic Appliances, Orthotic Devices, Randomized Controlled Trials as Topic, Sleep Apnea, Obstructive

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