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RAPID MAXILLARY EXPANSION IN PEDIATRIC OSA: IS IT AN ASSERTIVE OPTION?
Prevention of mouth breathing during the growth phase in children remains a challenge with significant clinical consequences. Studies show that obstructive sleep apnea (OSA), one of the most common sleep disorders in adults, may induce anatomo-functional changes during the critical period of craniofacial growth and development. Rapid maxillary expansion (RME) is an orthodontic procedure for OSA treatment in children, but currently available systematic reviews and meta-analysis are controversial around this subject. An exhaustive analysis with a critical report of several polysomnographic parameters is considered the gold standard to diagnose OSA. This umbrella review is aimed at comparing polysomnographic parameters with others from the literature reviews and related meta-analysis to provide more accurate information on the role of RME treatment in children with OSA therefore raising the question: Is RME treatment an assertive option in pediatric OSA?
This study is primarily aimed to assess the effectiveness of RME as a treatment option for OSA, compiling evidence from multiple research syntheses.
A comprehensive search of seven electronic databases (Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO, and Scopus) was performed during July 2021, including systematic review with meta-analysis in English, yielded eight studies of RME in children with OSA with polysomnographic measurements; of these, seven were included in the umbrella review. Data was extracted, and key findings were synthesized to clarify whether RME has consistent evidence so far to be indicated as a treatment for children with OSA.
No consistent evidence of long term RME effectiveness in pediatric OSA was found in the seven selected studies. A high heterogeneity in the inclusion criteria was detected.
Overall, this review supports the need for better methodological studies to answer the question: Is RME in pediatric OSA an assertive option? Alternative treatments should also be included in future research to confirm their comparative efficacy and therapeutic success, given the relevance of nasal breathing during craniofacial growth and development, considering disorders such as mouth breathing. A primary level of prevention in major respiratory diseases is needed to recognize early signs of OSA and the implement best health policies to improve children's quality of life.
Rapid maxillary expansion, obstructive sleep apnea, children, systematic review, meta-analysis.
FCM-UNICAMP - São Paulo - Brasil
Denise Fernandes Barbosa, Laura Fernandes Bana, Maria Cristina Buta Michel, Miguel Meira e Cruz, Edilson Zancanella, Almiro José Machado Júnior