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Management of paediatric obstructive sleep apnoea: A systematic review and network meta‐analysis
Author(s) -
Lin ShihYing,
Su YuXuan,
Wu YiCheng,
Chang Jenny ZweiChieng,
Tu YuKang
Publication year - 2020
Publication title -
international journal of paediatric dentistry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.183
H-Index - 62
eISSN - 1365-263X
pISSN - 0960-7439
DOI - 10.1111/ipd.12593
Subject(s) - medicine , meta analysis , obstructive sleep apnea , psychological intervention , randomized controlled trial , pediatrics , tonsillectomy , adenoidectomy , physical therapy , surgery , psychiatry
Background Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. Aim Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta‐analysis. Design Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea‐hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO 2 ). Frequentist approach to network meta‐analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. Results Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta‐analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO 2 . No comparisons showed statistical significance in reducing ODI. Conclusions Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.