Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children

Carvalho FR, Lentini-Oliveira DA, Machado MAC, Saconato H, Prado LBF, Prado GF

Published Online:

October 8, 2008

Treatment of obstructive sleep apnoea syndrome (OSAS) in children appears to be possible with oral appliances or functional orthopaedic appliances. However this is only based on data from one small study.
The common treatment for OSAS in childhood is adenotonsillectomy. This approach is limited by recurrence that can be associated with craniofacial problems. Oral/functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they change mandible posture forwards and potentially increase the upper airway, improving the respiratory function. At present there is no sufficient evidence to affirm that oral/functional orthopaedic appliances are effective in the treatment of OSAS in children.

Abstract (click to read)

Background:

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 comorbidities 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.

Objectives:

To assess the effectiveness of oral appliances or functional orthopaedic appliances for OSAS in children.

Search strategy:

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 (1986 to September 2005); and SciELO (1997 to September 2005).
There was no restriction of language or source of information.

Selection criteria:

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. Primary outcome: reduction of apnoea to less than one episode per hour. Secondary outcomes: 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 collection and analysis:

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.

Main results:

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.

This record should be cited as:

Carvalho FR, Lentini-Oliveira DA, Machado MAC, Saconato H, Prado LBF, Prado GF. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005520. DOI: 10.1002/14651858.CD005520.pub2

Assessed as up to date:

February 15, 2007

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Craniofacial anomalies > Orthodontic treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children

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