Mandibular advancement appliances for sleep-disordered breathing in children: A randomized crossover clinical trial
Abstract
Objective To test the short-term effectiveness of a mandibular advancement splint (MAS) for the management of sleep-disordered breathing (SDB) in children.Methods Eighteen SDB children were enrolled in a crossover randomized clinical trial and assigned to a treatment sequence starting either with an Active or a Sham MAS. Each appliance was worn for three weeks and treatment periods were separated by a two-week washout. Home-based polysomnographic data were collected before and after each treatment period. In addition, blood samples were collected at the end of each treatment period to assess serum levels of insulin-like growth factor-1 (IGF-1). The apnea-hypopnea index (AHI) and snoring time represented the main outcome variables. Secondary outcomes included IGF-1 levels, and questionnaire scores for quality of life and behavior.Results Compared to the Sham MAS, the wearing of the Active MAS resulted in a significant reduction in overall AHI (-37%; 95% CI = 15-53%; p = 0.002) and supine AHI (-4.1 events per hour; 95% CI = 1.8-6.4; p < 0.001). Mean snoring time per night was shorter with the Active MAS than with the Sham MAS (-46.3 min; 95% CI = 14.5-78.1; p = 0.004). Wearing of the Active MAS improved the ratings of quality of life and behavior (P ≤ 0.028), but there was no evidence that it influenced IGF-1 levels (P = 0.172).Conclusion Wearing an Active MAS overnight, over a short period can be beneficial for SDB children, resulting in a clinically relevant reduction of supine AHI.
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Studies specifically assessing long-term effects in pediatric populations remain scarce.
“Studies specifically assessing long-term effects in pediatric populations remain scarce [12, 15, 44]”
From Long-Term Changes Following Orthopedic Mandibular Advancement Therapy in Pediatric Obstructive Sleep Apnea: a 7-Year Follow-up Study (2026) · cites this paper as [44]
Studies incorporating polysomnography alongside structural assessment to evaluate functional outcomes of mandibular advancement in children are more limited in number.
“In contrast, studies incorporating polysomnography alongside structural assessment to evaluate functional outcomes of mandibular advancement in children are more limited in number [20–22, 42–45]”
From Long-Term Changes Following Orthopedic Mandibular Advancement Therapy in Pediatric Obstructive Sleep Apnea: a 7-Year Follow-up Study (2026) · cites this paper as [44]
There have been few studies investigating orthodontic treatment modalities for children with OSA with mandibular retrognathia.
“There have been few studies investigating the orthodontic treatment modalities for children with OSA with mandibular retrognathia [12–17], particularly studies assessing the use of twin-block appliances to treat mandibular retrognathia and protrusion.”
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 [12]
The lowest oxygen saturation showed a significant increase in two included studies, whereas there was no significant difference in another two included studies.
“The lowest oxygen saturation (minSaO 2 ) showed a significant increase in two studies [32,37] whereas there was no significant difference in another two [26,34].”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [32]
Long-term mandibular advancement appliance treatment (at least six months) may be more effective than short-term treatment for pediatric obstructive sleep apnea.
“Long-term treatment (at least six months) may be more effective than short-term treatment.”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [32]
Oxygen desaturation index decreased but showed no significant difference in two randomized controlled trials.
“Oxygen desaturation index (ODI) decreased but showed no significant difference in two RCTs [26,32].”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [32]
In children with obstructive sleep apnea, mandibular advancement appliance treatment reduces the apnea-hypopnea index compared with control/no treatment, with a mean difference in AHI change of -1.75 events/h (95% CI -2.07 to -1.44, p < 0.00001) in a meta-analysis of two high-quality randomized controlled trials.
“The mean difference in apneaehypopnea index (AHI) change for mandibular advancement group compared with control group was À1.75 events/h (95% confidence interval (CI) À2.07, À1.44), p < 0.00001.”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [32]
Two randomized controlled trials were assessed as at low risk of bias, considering that blinding of participants/personnel was impossible if the control group underwent no treatment and the primary outcomes were objective indicators.
“Two RCTs [32,35] were assessed as at low risk of bias considering that the blinding of participants/personnel was impossible if the control group underwent no treatment and the primary outcomes were objective indicators.”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [32]
Quality of life (OSA-18) and behavior (BASC-2 BESS questionnaire) improved after mandibular advancement appliance treatment in one included study.
“Quality of life (OSA-18) and behavior (BASC-2 BESS questionnaire) improved [32].”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [32]
In included studies, daytime and night-time symptoms related to obstructive sleep apnea diminished in treated subjects, and Epworth sleepiness scale and pediatric sleep questionnaire scores decreased.
“Symptoms related to OSA were evaluated by variable questionnaires: daytime symptoms (sleepiness, irritability, tiredness, oral breathing, nasal stuffiness) and night-time symptoms (habitual snoring, restless sleep) in treated subjects diminished [26], Epworth sleepiness scale (ESS) and pediatric sleep questionnaire (PSQ) scores decreased [32,34].”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [32]
Growth hormone levels assessed by insulin-like growth factor 1 increased after wearing a mandibular advancement appliance but the difference was not significant (p = 0.172).
“The latest study reported that growth hormone levels assessed by insulin-like growth factor 1 (IGF-1) increased after wearing an MAA but the difference was not significant (p ¼ 0.172) [32].”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [32]
Several randomized clinical trials suggest that orthodontic treatments, such as mandibular advancement with functional appliances, can be effective in the management of pediatric snoring and OSA.
“Several randomized clinical trials23, 24, 25 suggest that orthodontic treatments, such as mandibular advancement with functional appliances, can be effective in the management of pediatric snoring and OSA.”
From Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review (2022) · cites this paper as [24]
Removable functional appliances are less invasive and can be better tolerated than other modalities.
“Removable functional appliances are less invasive and can be better tolerated than other modalities.24”
From Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review (2022) · cites this paper as [24]
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Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases
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Treatment of Pediatric Sleep Apnea, a Critical Look at the Problem (literature review)
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- Authors
- Idris, G., Galland, B., Robertson, C. J., Gray, A., & Farella, M.
- Affiliations
- University of Otago (NZ)
- Corresponding author
- Farella, Mauro
- Venue
- Journal of Dentistry
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 71
- Pages
- 9-17
- ISSN
- 0300-5712 (ISSN-L)
- OpenAlex
- W2790228210
- Semantic Scholar
- 1b79059c10e60a6a5f82f95088b4941f2f4d390b
- Cited by
- 35
- References
- 71
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 1
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Dentistry (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
- mandibular advancement device, sleep-disordered breathing, pediatric obstructive sleep apnea, apnea-hypopnea index, snoring, insulin-like growth factor I, quality of life, behavior, home polysomnography
- MeSH terms
- Cephalometry, Child, Equipment Design, Female, Humans, Insulin-Like Growth Factor I, Male, New Zealand, Orthodontic Appliances, Quality of Life, Surveys and Questionnaires, Sleep Apnea Syndromes, Snoring, Splints, Body Mass Index, Treatment Outcome, Cross-Over Studies, Mandibular Advancement, Overbite, Anatomic Landmarks
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