Carvalho F R, Lentini-Oliveira D, Machado M A C, Prado G F, Prado L B F, Saconato H
Universidade Federal de São Paulo, Internal Medicine Department, Rua Padre Damaso, 314, Osasco, Centro, Brazil, 06016-010.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD005520. doi: 10.1002/14651858.CD005520.pub2.
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 adenotonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbities 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 change the mandible posture forwards and potentially enlarge the upper airway and increase the upper airspace, improving the respiratory function.
To assess the effectiveness of oral appliances or functional orthopaedic appliances for OSAS in children.
A sensitive search was developed for the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); PubMed (January 1966 to September 2005); EMBASE (1980 to September 2005); Lilacs (1982 to September 2005); BBO-Bibliografia Brasileira de Odontologia (1986 to September 2005); and SciELO (1997 to September 2005). There was no restriction of language or source of information.
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.
reduction of apnoea to less than one episode per hour.
dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiologic function, behavioural problems, drop outs and withdrawals, quality of life, side effects (tolerability), economic evaluation.
Data were independently extracted by two review authors. Authors were contacted for additional information. Risk ratios with 95% confidence intervals were calculated for all important dichotomous outcomes.
The initial search identified 384 trials. One of them, reporting results from a total of 23 patients, was suitable for inclusion in the review. Data provided in the published report did not answer all the questions from this review, but some of them were, and the presented results favour treatment.
AUTHORS' CONCLUSIONS: At present there is no sufficient evidence to state that oral appliances or functional orthopaedic appliances are effective in the treatment of OSAS in children. Oral appliances or functional orthopaedic appliances may be helpful in the treatment of children with craniofacial anomalies which are risk factors for apnoea.
呼吸暂停是一种以鼻或口无气流为特征的呼吸障碍。在儿童中，危险因素包括腺样体扁桃体肥大、肥胖、神经肌肉疾病和颅面畸形。儿童阻塞性睡眠呼吸暂停综合征（OSAS）最常见的治疗方法是腺样体扁桃体切除术。这种方法受到手术风险的限制，主要是在患有合并症的儿童中，而且在一些患者中，还会受到与颅面问题相关的复发的限制。口腔矫治器和功能性正畸矫治器已用于患有OSAS和颅面畸形的患者，因为它们可使下颌姿势向前改变，并可能扩大上气道和增加上气道空间，从而改善呼吸功能。
评估口腔矫治器或功能性正畸矫治器对儿童OSAS的疗效。
针对Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2005年第3期）、PubMed（1966年1月至2005年9月）、EMBASE（1980年至2005年9月）、Lilacs（1982年至2005年9月）、BBO-巴西牙科学文献目录（1986年至2005年9月）和SciELO（1997年至2005年9月）制定了敏感的检索策略。对语言或信息来源没有限制。
所有比较15岁及以下儿童使用各种口腔和功能性正畸矫治器与安慰剂或不治疗的随机或半随机对照试验。
将呼吸暂停减少至每小时少于1次发作。
牙齿和骨骼关系、睡眠参数改善、认知和听觉功能、行为问题、退出和失访、生活质量、副作用（耐受性）、经济评估。
由两名综述作者独立提取数据。与作者联系以获取更多信息。计算所有重要二分法结局的风险比及其95%置信区间。
初步检索确定了384项试验。其中一项报告了总共23名患者的结果，适合纳入本综述。已发表报告中提供的数据并未回答本综述中的所有问题，但回答了其中一些问题，且所呈现的结果支持治疗。
目前没有足够的证据表明口腔矫治器或功能性正畸矫治器对儿童OSAS的治疗有效。口腔矫治器或功能性正畸矫治器可能有助于治疗患有作为呼吸暂停危险因素的颅面畸形的儿童。
