Management of Obstructive Sleep Apnea in the Infant: A Systematic Review and Meta-analysis.

OBJECTIVE

To evaluate the improvement in respiratory parameters of infants with obstructive sleep apnea (OSA) treated with medical or surgical intervention.

DATA SOURCES

A comprehensive review was completed using the PubMed, Web of Science, Embase, and Cochrane libraries including articles published from 1975 to 2024.

REVIEW METHODS

Interventions studied included adenotonsillectomy, mandibular distraction osteogenesis (MDO), tongue/lip adhesion, partial glossectomy, floor-of-mouth release, supraglottoplasty, oral appliances, tracheostomy, and positioning. Continuous positive airway pressure (CPAP) served as a control. Outcomes studied included pre- and postintervention obstructive apnea-hypopnea index. Studies included randomized controlled trials and case-control trials. A total of 2161 records were identified, and 59 studies were included in the analysis. Data was extracted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and pooled using a random-effects model. The primary study outcome established prior to data collection was a change in the apnea-hypopnea index.

RESULTS

A meta-analysis of MDO performed in infants for OSA demonstrated an overall pooled mean difference (pre-apnea-hypopnea index minus post-apnea hypopnea index) of 30.1 (95% confidence interval: 22.9, 37.4; 10 studies, 373 patients). No other data was pooled for analysis due to study heterogeneity. All CPAP studies showed apnea resolution. Tailored therapies including supraglottoplasty and tongue-lip adhesion reduced but did not resolve apneic events.

CONCLUSION

Current investigations of the evaluation and treatment of infant OSA are limited by heterogeneity in reporting and study. Mandibular distraction and CPAP are promising.