Rapid maxillary expansion versus watchful waiting in pediatric OSA: A systematic review
Open accessAbstract
Spontaneous resolution of pediatric obstructive sleep apnea (OSA) may stand behind the observed benefit of rapid maxillary expansion (RME), mainly supported by uncontrolled case series. We aimed to review the controlled, ideally randomized, evidence on the effectiveness of RME as compared to watchful waiting or alternative treatment of pediatric OSA. We only found one randomized clinical trial comparing RME with watchful waiting. The other four studies compared RME with the gold-standard treatment adenotonsillectomy, three of them in a non-randomized fashion. The results of the RCT showed no statistically significant differences in the enhancement of main (apnea hypopnea index, AHI) and secondary outcomes between RME and watchful waiting. Furthermore, reproducibility of the published studies was limited by insufficient description of their patients' inclusion criteria. We could not find convincing evidence of the benefit of RME over watchful waiting in patients with pediatric OSA. RCTs with reproducible inclusion criteria comparing RME with watchful waiting are still critically needed to support this intervention for the treatment of pediatric OSA. In the absence of solid evidence with RCT, RME should not be recommended for the treatment of pediatric OSA. PROSPERO REGISTRATION NUMBER: CRD42021249261. RUNNING SUMMARY: This systematic review explores the benefits of rapid maxillary expansion compared to spontaneous resolution of pediatric obstructive sleep apnea.
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In children with OSA, rapid maxillary expansion (RME) is not superior to watchful waiting.
“Fernandez-Barriales M [24] et al. found no statistical difference between RME and watchful waiting. In children with OSA, no convincing evidence was found to prove that RME was superior to watchful waiting.”
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 [24]
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“Fernandez-Barriales M [24] et al. found no statistical difference between RME and watchful waiting.”
Global trends and hotspots on childhood obstructive sleep apnea: a 10-year bibliometric analysis
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- Authors
- Fernández-Barriales, M., Lafuente-Ibáñez de Mendoza, I., Alonso-Fernández Pacheco, J. J., & Aguirre-Urizar, J. M.
- Affiliations
- University of the Basque Country (ES)
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 62
- Pages
- 101609
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W4211110298
- Cited by
- 33
- References
- 72
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 10 · 2023: 10 · 2022: 1
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Sleep Medicine Reviews (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Communities in ADDI (Universidad del Pais Vasco) (submittedVersion, cc-by-nc-nd)
- Hispana (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- rapid maxillary expansion, pediatric obstructive sleep apnea, expectant management, adenotonsillectomy, spontaneous resolution, apnea-hypopnea index, treatment effectiveness, randomized controlled trials
- MeSH terms
- Adenoidectomy, Child, Humans, Palatal Expansion Technique, Reproducibility of Results, Randomized Controlled Trials as Topic, Sleep Apnea, Obstructive, Watchful Waiting
About these checks
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.
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