The Role of Rapid Maxillary Expansion in the Management of Obstructive Sleep Apnoea: Monitoring Respiratory Parameters-A Systematic Review and Meta-Analysis.

Obstructive sleep apnoea (OSA) is a sleep-related breathing condition that involves the presence of episodic disruptions to the sleeping pattern due to partial or complete airway obstruction. There are a range of treatment options that exist to alleviate the symptoms of this condition including CPAP, mandibular advancement, and maxillary expansion techniques. This systematic review and meta-analysis of published articles aims to determine if rapid maxillary expansion ("RME") is an effective treatment option in the management of OSA, using quantitative parameters of AHI and SpO. An exhaustive review of the literature was conducted on EBSCO, PubMed, and Scopus databases. The PICO question for the systematic review was "Can rapid maxillary expansion be used as a viable treatment option using comparative AHI and SpO parameters in the management of obstructive sleep apnoea?" A meta-analysis was also performed and the software used to carry out the meta-analysis was R 4.3.2 (R Core Team (2013)). From the initial search, 62 articles were found and a further 4 articles were obtained from manual findings. Nine articles were included in the final systematic review and meta-analysis. Eight of the studies concluded that RME was successful to varying degrees in the management of OSA across both outcome variables assessed. The meta-analysis indicated that RME is an effective treatment option in the management of adult and paediatric OSA with the improvement of both parameters. The paediatric OSA sample with specific pre-treatment anatomical presentation (clear maxillary deficiency, narrow hard palate with crossbite) showed a noted resolution of OSA following RME at a pre-pubertal age, indicating that RME can be employed as a genuine treatment option for paediatric OSA as suggested by theory. The systematic review and meta-analysis provided sufficient significant data in favour of the alternative hypothesis to indicate that RME is an effective treatment option in the management of obstructive sleep apnoea, in terms of the AHI reduction and SpO increase.