Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta‐analysis

Objectives/Hypothesis To perform a systematic review with meta‐analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA). Data Sources PubMed/MEDLINE and eight additional databases. Review Methods Three authors independently and systematically reviewed the international literature through February 21, 2016. Results Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high‐arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow‐up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3‐year follow‐up, the pre‐ and post‐RME apnea–hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is −1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73–95% reduction) than in children with large tonsils (61% reduction). For >3‐year follow‐up (range = 6.5–12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction). Conclusions Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3‐year follow‐up). Randomized trials and more studies reporting long‐term data (≥3‐year follow‐up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope , 2016 Laryngoscope, 127:1712–1719, 2017