title: Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis.
abstract: To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA).
  
  
  
  PubMed/MEDLINE and eight additional databases.
  
  
  
  Three authors independently and systematically reviewed the international literature through February 21, 2016.
  
  
  
  Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea-hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is -1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73-95% reduction) than in children with large tonsils (61% reduction). For >3-year follow-up (range = 6.5-12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction).
  
  
  
  Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up). Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope, 2016 Laryngoscope, 127:1712-1719, 2017.
authors: Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.|Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, California, U.S.A.
authors: Macario
authors: M
authors: Camacho
authors: Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.
authors: Edward T
authors: ET
authors: Chang
authors: Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.
authors: Sungjin A
authors: SA
authors: Song
authors: Sleep Surgery Department, Instituto Ferrero de Neurología y Sueño, Buenos Aires, Argentina.
authors: Jose
authors: J
authors: Abdullatif
authors: Division of Sleep Surgery and Medicine, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A.
authors: Soroush
authors: S
authors: Zaghi
authors: Department of Clinical Sciences and Translational Medicine, University of Rome, Rome, Tor Vergata, Italy.
authors: Paola
authors: P
authors: Pirelli
authors: Department of Otorhinolaryngology/Sleep Medicine Center, , Companhia União Fabril & Centro Hospitalar Entre Douro e Vouga Hospital, Porto, Portugal.|Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
authors: Victor
authors: V
authors: Certal
authors: Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, California, U.S.A.
authors: Christian
authors: C
authors: Guilleminault
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D010155:Palatal Expansion Technique; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D014068:Tonsillectomy
chemical_list: D010100:Oxygen
keywords: Obstructive sleep apnea; meta-analysis; sleep apnea; sleep medicine; systematic review