Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review

Abstract Introduction: Obstructive sleep apnea syndrome is a common condition in childhood and if left untreated can result in many health problems. An accurate diagnosis of the etiology is crucial for obstructive sleep apnea treatment success. Functional orthodontic appliances that stimulate mandibular growth by forward mandibular positioning are an alternative therapeutic option in growing patients. Objective: To perform a literature review about the effects of functional orthodontic appliances used to correct the mandibular deficiency in obstructive sleep apnea treatment. Methods: The literature search was conducted in June 2020 using Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS Ovid; SciELO Web of Science; EMBASE Bireme and BBO Bireme electronic databases. The search included papers published in English, until June 2020, whose methodology referred to the types and effects of functional orthopedic appliances on obstructive sleep apnea treatment in children. Results: The search strategy identified thirteen articles; only four articles were randomized clinical studies. All studies using the oral appliances or functional orthopedic appliances for obstructive sleep apnea in children resulted in improvements in the apnea-hypopnea index score. The cephalometric (2D) and tomographic (3D) evaluations revealed enlargement of the upper airway and increase in the upper airspace, improving the respiratory function in the short term. Conclusion: Functional appliances may bean alternative treatment for obstructive sleep apnea, but it cannot be concluded that they are effective in treating pediatric obstructive sleep apnea. There are significant deficiencies in the existing evidence, mainly due to absence of control groups, small sample sizes, lack of randomization and no long-term results.摘要与引言：阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome）是儿童期常见病症，若未及时治疗可引发诸多健康问题。明确病因诊断对阻塞性睡眠呼吸暂停综合征的治疗成功至关重要。通过前移下颌以刺激下颌生长的功能性正畸矫治器，是生长发育期患者的可选治疗方案。研究目的：针对用于矫正下颌发育不足的功能性正畸矫治器在阻塞性睡眠呼吸暂停综合征治疗中的效果开展文献综述。研究方法：本次文献检索于2020年6月开展，检索数据库涵盖Cochrane图书馆、PubMed、EBSCO（牙科与口腔科学资源库）、LILACS Ovid、SciELO Web of Science、EMBASE Bireme及BBO Bireme电子数据库。检索范围为截至2020年6月发表的英文文献，其研究方法需涉及功能性正畸矫形矫治器的类型及其对儿童阻塞性睡眠呼吸暂停综合征治疗的效果。研究结果：本次检索共筛选出13篇文献，其中仅4篇为随机对照临床研究。所有针对儿童阻塞性睡眠呼吸暂停综合征使用口腔矫治器或功能性正畸矫形矫治器的研究，均显示呼吸暂停低通气指数（apnea-hypopnea index）评分得到改善。头颅测量（二维）及断层扫描（三维）评估结果显示，上气道容积增大、上气道间隙增宽，可在短期内改善呼吸功能。研究结论：功能性矫治器或可作为阻塞性睡眠呼吸暂停综合征的替代治疗方案，但目前尚无足够证据证实其对儿童阻塞性睡眠呼吸暂停综合征的治疗有效性。现有证据存在显著缺陷，主要体现为缺乏对照组、样本量偏小、未采用随机分组方法且无长期随访结果。