Yu Min, Ma Yanyan, Xu Ying, Bai Jingxuan, Lu Yujia, Han Fang, Gao Xuemei
Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China; National Center for Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China.
Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China.
Sleep Med Rev. 2023 Dec;72:101855. doi: 10.1016/j.smrv.2023.101855. Epub 2023 Sep 28.
This systematic review and network meta-analysis aims to preliminarily investigate the efficacy of different orthodontic appliances for the treatment of pediatric obstructive sleep apnea (OSA). Electronic databases were systematically searched. Randomized and non-randomized controlled trials with patients <18 y treated with either mandibular advancement appliance (MAA), rapid maxillary expansion (RME), or myofunctional therapy (MFT) were included. A network meta-analysis using multivariate random effects was conducted to estimate pooled differences using the apnea-hypopnea index (AHI) as the main outcome. Eleven studies (595 patients) were included in the analysis. Compared with control, MAA was associated with significant reductions in AHI of -2.18/h (95%CI -3.48 to -0.89, p = 0.001). Combined treatment of RME + adenotonsillectomy (AT) and RME + MAA showed a significant decrease in AHI, with -5.13/h (95%CI -7.50 to -2.76, p < 0.0001) and -3.79 (95%CI -5.21 to -2.37, p < 0.0001), respectively. MFT was associated with a -2.45/h (95%CI -4.76 to -0.14, p = 0.038) decrease in AHI. However, RME alone was not associated with significant AHI reduction (0.02, 95%CI -1.72 to 1.75, p = 0.985). The heterogeneity of the network meta-analysis was I = 32.6%. Limited evidence indicated that MAA (alone or combined with RME) and RME + AT were associated with benefits for pediatric patients with OSA. This study could not find convincing evidence of a significant benefit of other orthodontic appliances over control.
本系统评价和网状Meta分析旨在初步研究不同正畸矫治器治疗小儿阻塞性睡眠呼吸暂停（OSA）的疗效。对电子数据库进行了系统检索。纳入了对18岁以下患者使用下颌前伸矫治器（MAA）、快速上颌扩弓（RME）或肌功能治疗（MFT）进行治疗的随机和非随机对照试验。采用多变量随机效应进行网状Meta分析，以呼吸暂停低通气指数（AHI）作为主要结局指标来估计合并差异。分析纳入了11项研究（595例患者）。与对照组相比，MAA使AHI显著降低2.18次/小时（95%置信区间为-3.48至-0.89，p = 0.001）。RME联合腺样体扁桃体切除术（AT）和RME联合MAA治疗使AHI显著降低，分别为5.13次/小时（95%置信区间为-7.50至-2.76，p < 0.0001）和3.79次/小时（95%置信区间为-5.21至-2.37，p < 0.0001）。MFT使AHI降低2.45次/小时（95%置信区间为-4.76至-0.14，p = 0.038）。然而，单纯RME未使AHI显著降低（0.02，95%置信区间为-1.72至1.75，p = 0.985）。网状Meta分析的异质性I² = 32.6%。有限的证据表明，MAA（单独或联合RME）和RME + AT对小儿OSA患者有益。本研究未找到令人信服的证据表明其他正畸矫治器比对照组有显著益处。
