Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children
- PMID: 27701747
- PMCID: PMC6458031
- DOI: 10.1002/14651858.CD005520.pub3
Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children
Abstract
Background: Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adeno-tonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbidities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they hold the lower jaw (mandible) forwards which potentially enlarges the upper airway and increases the upper airspace, improving the respiratory function.
Objectives: To assess the effects of oral appliances or functional orthopaedic appliances for obstructive sleep apnoea in children.
Search methods: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 7 April 2016); Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3) in the Cochrane Library (searched 7 April 2016); MEDLINE Ovid (1946 to 7 April 2016); Embase Ovid (1980 to 7 April 2016); LILACS BIREME (from 1982 to 7 April 2016); BBO BIREME (from 1986 to 7 April 2016) and SciELO Web of Science (from 1997 to 7 April 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials on 7 April 2016. We placed no restrictions on the language or date of publication when searching the electronic databases.
Selection criteria: All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger.
Primary outcome: reduction of apnoea to less than one episode per hour.
Secondary outcomes: dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiological function, behavioural problems, quality of life, side effects (tolerability) and economic evaluation.
Data collection and analysis: Two review authors screened studies and extracted data independently. Authors were contacted for additional information. We calculated risk ratios with 95% confidence intervals for all important dichotomous outcomes. We assessed the quality of the evidence of included studies using GRADEpro software.
Main results: The initial search identified 686 trials. Only one trial, reporting the results from a total of 23 children and comparing an oral appliance to no treatment, was suitable for inclusion in the review. The trial assessed apnoea-hypopnoea, daytime symptoms (sleepiness, irritability, tiredness, school problems, morning headache, thirstiness in the morning, oral breathing and nasal stuffiness) and night-time symptoms (habitual snoring, restless sleep and nightmares measured by questionnaire). Results were inconsistent across outcomes measures and time points. The evidence was considered very low quality.
Authors' conclusions: There is insufficient evidence to support or refute the effectiveness of oral appliances and functional orthopaedic appliances for the treatment of obstructive sleep apnoea in children. Oral appliances or functional orthopaedic appliances may be considered in specified cases as an auxiliary in the treatment of children who have craniofacial anomalies which are risk factors for apnoea.
Conflict of interest statement
Fernando R Carvalho: none known. Débora A Lentini‐Oliveira: none known. Lucila BF Prado: none known. Gilmar F Prado: none known. Luciane BC Carvalho: none known.
Figures
![1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-AFig-FIG02.gif)
![2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-AFig-FIG01.gif)
![1.1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-01.gif)
![1.2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-02.gif)
![1.3](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-03.gif)
![1.4](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-04.gif)
![1.5](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-05.gif)
![1.6](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-06.gif)
![1.7](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-07.gif)
![1.8](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-08.gif)
![1.9](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-09.gif)
![1.10](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-10.gif)
![1.11](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-11.gif)
![1.12](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6458031/bin/nCD005520-CMP-001-12.gif)
Update of
-
Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children.Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005520. doi: 10.1002/14651858.CD005520.pub2. Cochrane Database Syst Rev. 2007. Update in: Cochrane Database Syst Rev. 2016 Oct 05;10:CD005520. doi: 10.1002/14651858.CD005520.pub3. PMID: 17443598 Updated. Review.
Similar articles
-
Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children.Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005520. doi: 10.1002/14651858.CD005520.pub2. Cochrane Database Syst Rev. 2007. Update in: Cochrane Database Syst Rev. 2016 Oct 05;10:CD005520. doi: 10.1002/14651858.CD005520.pub3. PMID: 17443598 Updated. Review.
-
Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217. Cochrane Database Syst Rev. 2022. PMID: 36321557 Free PMC article.
-
Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents.Cochrane Database Syst Rev. 2018 Mar 13;3(3):CD003452. doi: 10.1002/14651858.CD003452.pub4. Cochrane Database Syst Rev. 2018. PMID: 29534303 Free PMC article. Review.
-
Oral appliances for obstructive sleep apnoea.Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004435. doi: 10.1002/14651858.CD004435.pub2. Cochrane Database Syst Rev. 2004. Update in: Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004435. doi: 10.1002/14651858.CD004435.pub3. PMID: 15495109 Updated. Review.
-
Oral appliances for obstructive sleep apnoea.Cochrane Database Syst Rev. 2003;(4):CD004435. doi: 10.1002/14651858.CD004435. Cochrane Database Syst Rev. 2003. Update in: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004435. doi: 10.1002/14651858.CD004435.pub2. PMID: 14584014 Updated. Review.
Cited by
-
Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review.Sleep Sci. 2023 Nov 22;16(4):e468-e475. doi: 10.1055/s-0043-1776747. eCollection 2023 Dec. Sleep Sci. 2023. PMID: 38197023 Free PMC article. Review.
-
Management of the pediatric patient with asthma and obesity.Ann Allergy Asthma Immunol. 2024 Jan;132(1):30-39. doi: 10.1016/j.anai.2023.10.001. Epub 2023 Oct 10. Ann Allergy Asthma Immunol. 2024. PMID: 37827386 Review.
-
Dental Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis.Medicina (Kaunas). 2023 Aug 10;59(8):1447. doi: 10.3390/medicina59081447. Medicina (Kaunas). 2023. PMID: 37629737 Free PMC article. Review.
-
Early Childhood Caries and Sleep Disorders.J Clin Med. 2023 Feb 9;12(4):1378. doi: 10.3390/jcm12041378. J Clin Med. 2023. PMID: 36835914 Free PMC article.
-
Parental report of dental pain and discomfort in preschool children is associated with sleep disorders: a cross-sectional study in Brazilian families.Eur Arch Paediatr Dent. 2023 Feb;24(1):43-53. doi: 10.1007/s40368-022-00747-1. Epub 2022 Sep 20. Eur Arch Paediatr Dent. 2023. PMID: 36125631
References
References to studies included in this review
Villa 2002 {published data only}
-
- Villa M, Bernkopf E, Pagani J, Barreto M, Broia V, Massa F, et al. An oral appliance for the treatment of obstructive sleep apnea in children. American Journal of Respiratory and Critical Care Medicine 2000;161(3 (Suppl)):A27. - PubMed
-
- Villa MP, Bernkopf E, Pagani J, Broia V, Montesano M, Ronchetti R. Randomized controlled study of an oral jaw‐positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. American Journal of Respiratory and Critical Care Medicine 2002;165(1):123‐7. - PubMed
References to studies excluded from this review
Ghodke 2014 {published data only}
Guilleminault 2011 {published data only}
-
- Guilleminault C, Monteyrol PJ, Huynh NT, Pirelli P, Quo S, Li K. Adeno‐tonsillectomy and rapid maxillary distraction in pre‐pubertal children, a pilot study. Sleep & Breathing 2011;15(2):173‐7. - PubMed
Nunes 2011 {published and unpublished data}
-
- Nunes Junior WR, Francesco RC. Snoring children treatment with orthodontic and orthopedic appliance ‐ randomized clinical trial. Sleep & Breathing 2011;15(2):257‐8.
-
- Nunes Junior WR, Francesco‐Mion RCD. Early treatment and preventive strategies for obstructive sleep apnea and hypopnea with the bioajusta x orthodontic‐orthopedic treatment. Sleep Medicine 2009;10 Suppl 2:S41‐2.
Additional references
AAP Guideline 2002
-
- American Academy of Pediatrics (AAP). Subcommittee on Obstructive Sleep Apnea Syndrome. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109(4):704‐12. - PubMed
Begg 1996
-
- Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, et al. Improving the quality of reporting of randomised controlled trials. The CONSORT statement. JAMA 1996;276(8):637‐9. - PubMed
Bell 2001
-
- Bell RB, Turvey TA. Skeletal advancement for the treatment of obstructive sleep apnea. The Cleft Palate‐Craniofacial Journal 2001;38(2):147‐54. - PubMed
Brouillette 1982
-
- Brouillette RT, Fernbach SK, Hunt CE. Obstructive sleep apnea in infants and children. The Journal of Pediatrics 1982;100(1):31‐40. - PubMed
Carroll 1995a
-
- Carroll JL, Loughlin GM. Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology. In: Ferber R, Kryger M editor(s). Principles and Practice of Sleep Medicine in the Child. Saunders (WB) Co Ltd, 1995:163‐91.
Carroll 1995b
-
- Carrol JL, Loughlin GM. Obstructive sleep apnea syndrome in infants and children: diagnosis and management. In: Ferber R, Kryger M editor(s). Principles and Practice of Sleep Medicine in the Child. Saunders (WB) Co Ltd, 1995:193‐216.
Carroll 2003
-
- Carroll JL. Obstructive sleep disordered breathing in children: new controversies, new directions. Clinics in Chest Medicine 2003;24(2):261‐82. - PubMed
Carvalho 2014
Chan 2004
-
- Chan J, Edman JC, Koltai PJ. Obstructive sleep apnea in children. American Family Physician 2004;69(5):1147‐54. [MEDLINE: ] - PubMed
Chervin 1997
-
- Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997;20(12):1185‐92. - PubMed
Defabjanis 2003
-
- Defabjanis P. Impact of nasal airway obstruction on dentofacial development and sleep disturbances in children: preliminary notes. Journal of Clinical Pediatric Dentistry 2003;27(2):95‐100. - PubMed
Egger 1997
Goldstein 2000
-
- Goldstein NA, Post JC, Rosenfeld RM, Campbell TF. Impact of tonsillectomy and adenoidectomy on child behavior. Archives of Otolaryngology Head & Neck Surgery 2000;126(4):494‐8. - PubMed
Guilleminault 1989
-
- Guilleminault C, Partinen M, Praud JP, Quera‐Salva MA, Powell N, Riley R. Morphometric facial changes and obstructive sleep apnea in adolescents. The Journal of Pediatrics 1989;114(6):997‐9. - PubMed
Guilleminault 1990
-
- Guilleminault C, Stoohs R. Chronic snoring and obstructive sleep apnea syndrome in children. Lung 1990;168 Suppl:912‐9. - PubMed
Guilleminault 2008
Higgins 2011
-
- Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Kheirandish‐Gozal 2006
Kohler 2008
Marcus 1992
-
- Marcus CL, Omlin KJ, Basinki DJ, Bailey SL, Rachal AB, Pechmann WS, et al. Normal polysomnographic values for children and adolescents. The American Review of Respiratory Disease 1992;146(5 Pt 1):1235‐9. - PubMed
Marcus 2001
-
- Marcus CL. Sleep‐disordered breathing in children. American Journal of Respiratory and Critical Care Medicine 2001;164(1):16‐30. - PubMed
Marcus 2012
-
- Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130(3):e714‐55. - PubMed
Moher 2001
-
- Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomized trials. Lancet 2001;357(9263):1191‐4. - PubMed
Nixon 2005
Schechter 2002
-
- Schechter MS. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109(4):e69. - PubMed
Shintani 1998
-
- Shintani T, Asakura K, Kataura A. The effect of adenotonsillectomy in children with OSA. International Journal of Pediatric Otorhinolaryngology 1998;44(1):51‐8. - PubMed
Tarasiuk 2007
-
- Tarasiuk A, Greenberg‐Dotan S, Simon‐Tuval T, Freidman B, Goldbart AD, Tal A, et al. Elevated morbidity and health care use in children with obstructive sleep apnea syndrome. American Journal of Respiratory and Critical Care Medicine 2007;175(1):55‐61. - PubMed
Uliel 2004
-
- Uliel S, Tauman R, Greenfeld M, Sivan Y. Normal polysomnographic respiratory values in children and adolescents. Chest 2004;125(3):872‐8. - PubMed
Viva 1992
-
- Viva E, Stefini S, Annibale G, Pedercini R, Zucconi M, Strambi LF. Aspects of prevention of obstructive sleep apnea syndrome in developing children. Advances in Otorhinolaryngology 1992;47:284‐9. - PubMed
Ward 1996
-
- Ward SL, Marcus CL. Obstructive sleep apnea in infants and young children. Journal of Clinical Neurophysiology 1996;13(3):198‐207. - PubMed
References to other published versions of this review
Carvalho 2005
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Miscellaneous