title: Maxillary expansion and maxillomandibular expansion for adult OSA: A systematic review and meta-analysis.
abstract: OBJECTIVE
  This study sought to systematically review the international literature for articles evaluating maxillary expansion and maxillomandibular expansion as treatments for obstructive sleep apnea (OSA) in adults and to perform a meta-analysis.
  
  
  METHODS
  Nine databases (including MEDLINE/PubMed).
  
  
  METHODS
  Searches were performed through January 8, 2016. The PRISMA statement was followed.
  
  
  RESULTS
  Eight adult studies (39 patients) reported polysomnography and/or sleepiness outcomes. Six studies reported outcomes for maxillary expansion (36 patients), and the apnea-hypopnea index (AHI) decreased from a mean (M) ± standard deviation (SD) of 24.3 ± 27.5 [95% CI 15.3, 33.3] to 9.9 ± 13.7 [95% CI 5.4, 14.4] events/hr (relative reduction: 59.3%). Maxillary expansion improved lowest oxygen saturation (LSAT) from a M ± SD of 84.3 ± 8.1% [95% CI 81.7, 87.0] to 86.9 ± 5.6% [95% CI 85.1, 88.7]. Maxillomandibular expansion was reported in two studies (3 patients) and AHI decreased from a M ± SD of 47.53 ± 29.81 [95% CI -26.5 to 121.5] to 10.7 ± 3.2 [95% CI 2.8, 18.6] events/hr (relative reduction: 77.5%). Maxillomandibular expansion improved LSAT from a M ± SD of 76.7 ± 14.5% [95% CI 40.7, 112.7] to 89.3 ± 3.1 [95% CI 81.6, 97].
  
  
  CONCLUSIONS
  The current literature demonstrates that maxillary expansion can improve and maxillomandibular expansion can possibly improve AHI and LSAT in adults; however, given the paucity of studies, these remain open for additional research efforts.
authors.affiliation: Department of Otorhinolaryngology, Hospital Bernardino Rivadavia, Buenos Aires, Argentina.
authors.forename: Jose
authors.initials: J
authors.lastname: Abdullatif
authors.affiliation: Department of Otorhinolaryngology, Sleep Medicine Centre, Hospital CUF, Porto, Portugal; CINTESIS - Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Certal
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, CA 95304, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
authors.affiliation: Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Sungjin A
authors.initials: SA
authors.lastname: Song
authors.affiliation: Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Chang
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: M Boyd
authors.initials: MB
authors.lastname: Gillespie
authors.affiliation: Otolaryngology - Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA; Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, CA 95304, USA. Electronic address: drcamachoent@yahoo.com.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
mesh_terms: D006801:Humans; D010100:Oxygen / Q000097:blood; D010155:Palatal Expansion Technique; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
chemical_list: D010100:Oxygen
keywords: Maxillary expansion; Maxillomandibular expansion; Meta-analysis; Sleep apnoea syndromes; Systematic review