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Cited by 57Obstructive Sleep Apnea ResearchTemporomandibular Joint DisordersOrthodontics and Dentofacial Orthopedics

Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis

Open access
Yanyan, Ma, Min, Yu, Xuemei, Gao·2019·Sleep Medicine
DOI 10.1016/j.sleep.2018.12.022
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Abstract

The objective of this review was to evaluate the effect of mandibular advancement appliances (MAAs) for obstructive sleep apnea (OSA) in children. To this end, several electronic databases (PubMed, EMBASE, Cochrane Library) were systematically searched until 18 June 2018. Randomized and non-randomized clinical trials were included. Articles of high-quality were included for the meta-analysis. Data extraction and quality assessment were conducted by two independent reviewers. Four randomized controlled trials (RCTs) and three non-RCTs were finally included in the review; of these, two RCTs of high-quality were included in the meta-analysis. The mean difference in apnea-hypopnea index (AHI) change for mandibular advancement group compared with control group was -1.75 events/h (95% confidence interval (CI) -2.07, -1.44), p < 0.00001. Sensitivity analysis including the quasi-randomized RCT and non-RCTs showed stable favorable results for MAAs. The meta-analysis showed supportive evidence for MAA treatment in pediatric OSA patients. Subgroup analysis suggested that MAA can be effective for mild to severe patients before the end of the pubertal peak. Long-term treatment (at least six months) may be more effective than short-term treatment.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found supportive evidence that mandibular advancement appliances reduce AHI in children with OSA compared with control/no treatment. Two high-quality RCTs showed a mean AHI-change difference of -1.75 events/h, with sensitivity analyses stable and subgroup signals for severity and longer treatment duration.

Key findings

  • In the primary meta-analysis of two high-quality RCTs (34 patients total; 17 MAA, 17 control), the mean difference in AHI change for MAA vs control was -1.75 events/h (95% CI -2.07 to -1.44), p < 0.00001; heterogeneity I² = 0% (p = 0.78).
  • Sensitivity analysis including the quasi-randomized RCT gave -1.79 events/h (95% CI -2.10 to -1.48), p < 0.00001; pooling treatment data from all studies except one abstract without AHI gave a reduction of 4.23 events/h (95% CI 1.07 to 7.38), with high heterogeneity (I² = 98%).
  • Subgroup analysis by severity showed AHI reduction percentages of about 50% for mild (1.72/3.5), 57% for moderate (4.27/7.5), and 76% for severe (10.69/14.08); no significant age subgroup difference (I² = 0%, p = 0.59), suggesting effectiveness before 13 years old.
  • Treatment-duration subgroup difference was observed (I² = 65.9%, p = 0.05), suggesting long-term treatment (6 months, 10–12 months) may be more effective than short-term; secondary outcomes were mixed (e.g., minSaO2 increased significantly in two studies but not in two others; ODI decreased without significance in two RCTs).

Methods

  • Systematic review and meta-analysis following PRISMA; searched PubMed, EMBASE, and Cochrane Library from inception to 18 June 2018, plus Google Scholar and reference-list manual searches, without language restrictions.
  • Included RCTs and non-randomized controlled trials of children/adolescents ≤18 years with OSA without craniofacial syndromes, comparing mandibular advancement appliances with or without a control group; primary outcome AHI, secondary outcomes oxygen saturation, sleep quality, and upper-airway space.
  • Seven original studies (4 RCTs, 3 non-RCTs) were included; two high-quality RCTs entered the primary meta-analysis. Two reviewers independently extracted data and assessed risk of bias with the Cochrane tool; RevMan 5.3 was used, with fixed-effects if I² < 50% and random-effects otherwise.

Limitations

  • Stated: only two RCTs were included in the primary meta-analysis and the sample size was small; more well-designed RCTs with large sample sizes are needed.
  • Stated: the meta-analysis was restricted to AHI, while other important outcomes (quality of life, sleep structure, craniofacial development) were not always available or were inconsistent, preventing meta-analysis; appliance types were too divergent to group.
  • Evident from the text: the pooled NRCT analysis had high heterogeneity (I² = 98%); the sensitivity analysis assumed control ΔAHI = 0 and the same SD as the MAA group; and the treatment-duration conclusion should be interpreted with caution because only one short-term study was included.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.sleep.2018.12.022

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 33 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    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.”
    • Also stated in: § 3.4. Data synthesis · plain
      “The mean difference in DAHI for MAA compared with control was À1.75 events/h (95% confidence interval (CI) À2.07, À1.44), p < 0.00001 (see Fig. 4).”
    • Also stated in: § 5. Conclusions · plain
      “The meta-analysis of two high-quality RCTs showed supportive evidence for MAA treatment in pediatric OSA patients.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [32] Idris, 2018, Mandibular advancement appliances for sleep-disordered breathing in children: a randomized crossover clinical trial, J Dent source

      Not checked in the free run.

    • cites [35] Machado-Júnior, 2016, Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: a pilot study, Med Oral Patol Oral Cir Bucal

      Not checked in the free run.

  • Findingown data

    In a sensitivity analysis including the quasi-randomized RCT, the mean difference in AHI change for mandibular advancement appliance compared with control remained stable at -1.79 events/h (95% CI -2.10 to -1.48, p < 0.00001).

    “The results remained stable, and DAHI for MAA compared with control was À1.79 events/h, (95% CI -2.10, À1.48), p < 0.00001 (see Fig. 5).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Villa, 2002, Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion, Am J Respir Crit Care Med source

      Not checked in the free run.

    • The authors state this as an assumption: In the sensitivity analysis, the change in AHI of the control group in the quasi-randomized study was assumed to be 0, and the standard deviation was assumed to be the same as that of the mandibular advancement appliance group.
  • Findingcitation

    Airway volume increased as measured by acoustic pharyngometry and magnetic resonance imaging in included studies.

    “Airway volume increased measured by acoustic pharyngometry and magnetic resonance imaging [33,36].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [33] Nunes, 2009, Early treatment and preventive strategies for obstructive sleep apnea and hypopnea with the bioajusta x orthodontic- orthopedic treatment, Sleep Med source

      Not checked in the free run.

    • cites [36] Schütz, 2011, Class II correction improves nocturnal breathing in adolescents, Angle Orthod source

      Not checked in the free run.

  • Findingcitation

    Cephalometric measurements showed a significant increase in the superior posterior airway space and middle airway space after mandibular advancement appliance treatment.

    “Moreover, cephalometric measurements showed a significant increase in the superior posterior airway space, and middle airway space [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Zhang, 2013, Effects of twin block appliance on obstructive sleep apnea in children: a preliminary study, Sleep Breath source

      Not checked in the free run.

  • Findingcitation

    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].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Idris, 2018, Mandibular advancement appliances for sleep-disordered breathing in children: a randomized crossover clinical trial, J Dent source

      Not checked in the free run.

  • May combine two claims. 17
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Findingcitation

    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].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] Villa, 2002, Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion, Am J Respir Crit Care Med source

      Not checked in the free run.

    • cites [32] Idris, 2018, Mandibular advancement appliances for sleep-disordered breathing in children: a randomized crossover clinical trial, J Dent source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    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].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [32] Idris, 2018, Mandibular advancement appliances for sleep-disordered breathing in children: a randomized crossover clinical trial, J Dent source

      Not checked in the free run.

    • cites [37] Zhang, 2013, Effects of twin block appliance on obstructive sleep apnea in children: a preliminary study, Sleep Breath source

      Not checked in the free run.

    • cites [26] Villa, 2002, Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion, Am J Respir Crit Care Med source

      Not checked in the free run.

    • cites [34] Cozza, 2004, Management of obstructive sleep apnoea in children with modified monobloc appliances, Eur J Paediatr Dent

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In a meta-analysis pooling only treatment data from all included studies except one abstract without AHI testing, the reduction of AHI after mandibular advancement appliance treatment was 4.23 events/h (95% CI 1.07 to 7.38), with high heterogeneity (I2 = 98%).

    “Reduction of AHI after treatment was 4.23 events/h, (95% CI: 1.07, 7.38), which was stronger than the meta-analysis result of only RCTs (see Fig. 6).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [34] Cozza, 2004, Management of obstructive sleep apnoea in children with modified monobloc appliances, Eur J Paediatr Dent

      Not checked in the free run.

    • cites [36] Schütz, 2011, Class II correction improves nocturnal breathing in adolescents, Angle Orthod source

      Not checked in the free run.

    • cites [37] Zhang, 2013, Effects of twin block appliance on obstructive sleep apnea in children: a preliminary study, Sleep Breath source

      Not checked in the free run.

    • Rests on an assumption: It is unethical to withhold treatment for children with retrognathic mandible during the growth period.

  • May combine two claims.

    Findingcitation

    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].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [26] Villa, 2002, Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion, Am J Respir Crit Care Med source

      Not checked in the free run.

    • cites [32] Idris, 2018, Mandibular advancement appliances for sleep-disordered breathing in children: a randomized crossover clinical trial, J Dent source

      Not checked in the free run.

    • cites [34] Cozza, 2004, Management of obstructive sleep apnoea in children with modified monobloc appliances, Eur J Paediatr Dent

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    After mandibular advancement appliance treatment, the number of respiratory effort-related arousals reduced, and there was a reduction in the relative proportions of stage 1 and stages 3-4 sleep as well as an increase in the percentage of stage 2 sleep.

    “As for sleep architecture, the number of respiratory effort-related arousals reduced, and a reduction in the relative proportions of stage 1 and stages 3e4 as well as an increase in the percentage of stage 2 after treatment were observed, which may be explained by brain maturation [36].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Schütz, 2011, Class II correction improves nocturnal breathing in adolescents, Angle Orthod source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    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].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Idris, 2018, Mandibular advancement appliances for sleep-disordered breathing in children: a randomized crossover clinical trial, J Dent source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    A few articles about the effectiveness of mandibular advancement appliances for pediatric obstructive sleep apnea have been published since the previous Cochrane review.

    “A few articles about the effectiveness of MAAs for pediatric OSA have been published since then.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Another randomized controlled trial was assessed as at high risk of bias because it used a quasi-random method of allocation (alphabetically by surname) and the percentage of dropouts was higher than 20%.

    “And another RCT [26] was assessed as at high risk of bias because they used a quasi-random method of allocation (alphabetically by surname), and the percentage of dropouts was higher than 20%.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Villa, 2002, Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion, Am J Respir Crit Care Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two reviewers independently evaluated the quality of the studies, and a third reviewer was consulted when there was disagreement.

    “Two reviewers (M.Y. and Y.M.) independently evaluated the quality of the studies; a third reviewer (G.X.) was consulted when there was disagreement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    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.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [32] Idris, 2018, Mandibular advancement appliances for sleep-disordered breathing in children: a randomized crossover clinical trial, J Dent source

      Not checked in the free run.

    • cites [35] Machado-Júnior, 2016, Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: a pilot study, Med Oral Patol Oral Cir Bucal

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement checklist was followed in this systematic review.

    “The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement checklist was followed in this systematic review [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Liberati, 2009, The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration, PLoS Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used to evaluate the risk of bias in individual studies.

    “To evaluate the risk of bias in individual studies, the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used [28].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Higgins, 2011, The Cochrane Collaboration's tool for assessing risk of bias in randomised trials, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two reviewers independently selected the articles, and discrepancies were resolved by discussion with each other and consultation with a third reviewer.

    “Two reviewers (M.Y. and Y.M.) independently selected the articles, and discrepancies were resolved by discussion with each other and consultation with a third reviewer (G.X.).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Data items were extracted from each included study by two reviewers independently.

    “The following data items were extracted from each study included by two reviewers independently: author, year of publication, study design, subjects, age, interventions, wearing time, drop out, AHI before and after MAA (only effects of MAA would be pooled if combined with other treatment), and secondary outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    For the meta-analysis of two high-quality randomized controlled trials, the test for heterogeneity was I2 = 0% (p = 0.78), and a fixed-effects model was used.

    “The test for heterogeneity was I 2 ¼ 0% (p ¼ 0.78), and a fixed-effects model was used.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Mandibular advancement could increase the dimensions of the upper airway and potentially eliminate risk factors for obstructive sleep apnea in adulthood.

    “This could increase the dimensions of the upper airway and potentially eliminate risk factors for OSA in adulthood [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Restrepo, 2011, Oropharyngeal airway dimensions after treatment with functional appliances in class II retrognathic children, J Oral Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Adenotonsillectomy markedly improves but does not necessarily normalize polysomnographic findings in children with adenotonsillar hypertrophy and related sleep-disordered breathing, especially in those with underlying skeletal deformities.

    “Adenotonsillectomy markedly improves but does not necessarily normalize polysomnographic findings in children with adenotonsillar hypertrophy and related sleep-disordered breathing, especially in those with underlying skeletal deformities [17e19].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17e19]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The use of mandibular advancement appliances for pediatric obstructive sleep apnea has not been widely studied and an evidence-based review is needed.

    “The use of mandibular advancement appliances (MAAs) for pediatric OSA has not been widely studied and an evidence-based review is needed.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    At the time of the previous Cochrane review, there was not enough high-quality evidence to affirm that oral appliances and functional orthopedic appliances are effective in the treatment of obstructive sleep apnea in children.

    “At that time, there was not enough high-quality evidence to affirm that oral appliances and functional orthopedic appliances are effective in the treatment of OSA in children [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Villa, 2002, Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion, Am J Respir Crit Care Med source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    There were only two randomized controlled trials included in the primary meta-analysis and the sample size was small.

    “There were only two RCTs included in the primary metaanalysis and the sample size was small.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The meta-analysis was restricted to the most frequently used AHI value, and other important clinical outcomes such as quality of life, sleep structure, and craniofacial development were not always available or were inconsistent, so meta-analysis of these outcomes was not possible.

    “This meta-analysis was restricted to the most frequently used AHI value, and other important clinical outcomes, such as quality of life, sleep structure, and craniofacial development, were not always available or inconsistent in published studies, and meta-analysis of these outcomes has not been possible.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    In pediatric obstructive sleep apnea, mandibular advancement aims to correct a retrognathic mandible by re-directing its growth into a more forward position and stimulating mandibular growth in a passive or active manner.

    “Mandibular advancement is widely used in adult OSA, while in the treatment of pediatric OSA, it aims to correct retrognathic mandible by re-directing its growth into a more forward position and stimulates mandibular growth in a passive or active manner [22], which may be accomplished by various functional appliances, such as twin-block, activator, Herbst, Frankel-II, and Bionator, etc. [23].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [22] Huynh, 2016, Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis, Sleep Med Rev source

      Not checked in the free run.

    • cites [23] Proffit, 2012

      Not checked in the free run.

22 of 22

  • The authors state this as an assumption.

    In the sensitivity analysis, the change in AHI of the control group in the quasi-randomized study was assumed to be 0, and the standard deviation was assumed to be the same as that of the mandibular advancement appliance group.

    “According to the randomization principle, we assumed that the change in AHI (DAHI) of the control group was 0, and the standard deviation was as same as that of the MAA group.”

  • The paper relies on this without support.

    It is unethical to withhold treatment for children with retrognathic mandible during the growth period.

    “Three NRCTs [34,36,37] did not consist of a control group because it was considered unethical to withhold treatment for children with retrognathic mandible in the growth period.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A meta-analysis of randomized and non-randomized trials reported a significant reduction in AHI compared to control in children treated with mandibular advancement appliances.

    “A meta-analysis of randomized and non-randomized trials reported a significant reduction in AHI compared to control in children treated with mandibular advancement appliances [16]”

    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 [16]

    The Abstract reports a significant AHI reduction versus control in children treated with mandibular advancement appliances. However, section 3.4 says that comparison pooled only two randomized trials; section 3.5 says the analysis including non-randomized trials compared AHI before and after treatment, not against controls. The claim conflates those two analyses. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • 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 [17]

  • Studies 17 through 21 were carried out with children who had not undergone adenotonsillar surgery.

    “Studies 17 18 19 20 21 were carried out with children who had not undergone adenotonsillar surgery.”

    From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [17]

  • In most included studies, mandibular advancement appliance treatment had a minimum duration of 6 months, except for a subgroup treated for 3 weeks in Yanyan et al.

    “In most studies, the MAAs treatment had a minimum duration of 6 months, with the exception of a subgroup treated for 3 weeks in the study by Yanyan et al. 17”

    From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [17]

  • Mandibular advancement is well established in adult obstructive sleep apnea treatment.

    “Another therapeutic resource can be found in MAAs: mandibular advancement is well established in adult OSA treatment; in children, the aim is to correct mandibular retrognathia through redirection and stimulation of anterior mandibular growth, in a passive or active manner, which can be achieved through different appliances, such as the Herbst, Frankell II, twin-block, and others. 17”

    From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [17]

Cites

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Related

Authors
Yanyan, M., Min, Y., & Xuemei, G.
Affiliations
Peking University (CN)
Corresponding author
Xuemei, Gao
Venue
Sleep Medicine
Publisher
Elsevier BV
Published
2019-08
Volume
60
Pages
145-151
ISSN
1389-9457 (ISSN-L)
DOI
10.1016/j.sleep.2018.12.022
OpenAlex
W2914141471
Semantic Scholar
805bdbaf41b848691ca0d59e3e6f4ca48a2cf8d2
Cited by
55
References
42
Citations by year
2026: 4 · 2025: 10 · 2024: 7 · 2023: 8 · 2022: 6 · 2021: 12 · 2020: 5 · 2019: 3
FWCI
0.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Sleep Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • National Natural Science Foundation of China (81470272)
  • Medicine and Engineering Sciences of Peking University (BMU20140397)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
  • Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
Keywords
mandibular advancement device, obstructive sleep apnea, pediatric sleep apnea, apnea-hypopnea index, treatment effectiveness, pubertal development, long-term treatment duration
MeSH terms
Child, Humans, Pediatrics, Sensitivity and Specificity, Mandibular Advancement, Sleep Apnea, Obstructive

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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