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 21.54 (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 5 +/- .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.