The DOI matches its Crossref record; 97 of the 101 references it cites were found in a registry or an index.
Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children
Open accessAbstract
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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In the citing paper
“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 the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“They are able to increase upper airway space, 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]
In the citing paper
“Although adenotonsillectomy is widely performed to treat pediatric OSA around the world, recurrence is very common, particularly in children with skeletal deformities, such as mandibular retrognathia, maxillary constriction, or both. 20”
From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [20]
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Functional Appliances in the Treatment of Sleep Apnea in Children: A Systematic Review
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Craniofacial Signs, Symptoms and Orthodontic Objectives of Paediatric Obstructive Sleep Apnoea
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Metadata
- 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
- 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
- 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
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Dentistry › Oral Surgery › 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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