THE ROLE OF ORTHODONTICS IN SLEEP APNEA MANAGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF MAXILLARY EXPANSION AND MANDIBULAR ADVANCEMENT
Main Article Content
Keywords
Obstructive sleep apnea, Maxillary expansion, Mandibular advancement device, Orthodontics, Airway volume, Apnea-hypopnea index, Non-invasive therapy
Abstract
Background
Obstructive sleep apnea (OSA) exists as a common sleep condition which causes repeated upper airway closure during sleep while producing disrupted sleep cycles along with wide-ranging health manifestations across the body. The gold standard therapy is continuous positive airway pressure (CPAP) yet non-standard approaches are gaining attention because patients do not comply well with their CPAP equipment. The treatment strategies of maxillary expansion together with mandibular advancement devices (MADs) prove effective for reducing obstructive sleep apnea because they correct the biological factors that block airways.
Objectives
This systematic review and meta-analysis aimed to evaluate the efficacy of maxillary expansion and mandibular advancement in managing OSA, focusing on their impact on airway dimensions and apnea-hypopnea index (AHI).
Methodology
The search based on PRISMA guidelines included clinical studies from 2000 through 2024 which were accessed in PubMed, Scopus, Web of Science, and Cochrane Library databases. The research included only original studies that examined how orthodontic procedures (maxillary expansion or mandibular advancement) affect AHI measurements as well as upper airway volume results in pediatric and adult patients diagnosed with OSA. A total of 18 studies evaluated the eligibility with four original high-quality articles among them. A random-effects model performed the data extraction while the I² statistic calculated heterogeneity levels.
Results
All the analyzed studies showed patients receiving orthodontic therapy experienced improvements in their respiratory function. Medical research indicates that MADs produce an average AHI decline between 33% and 55% in patients diagnosed with OSA at the mild to moderate levels. Scientific studies indicate rapid as well as semi-rapid maxillary expansion methods boost upper airway dimensions while decreasing nasal airflow resistance especially in child patients. Preliminary data review shows OSA severity reduction through these treatments leads to positive outcomes but a submission of quantitative assessment data is necessary to validate statistical significance and establish effect sizes.
Conclusion
Orthodontic approaches, particularly mandibular advancement devices and maxillary expansion techniques, represent effective, non-invasive alternatives for OSA management. Orthodontics works well as a treatment option for OSA patients with craniofacial problems and those who cannot use CPAP devices. Standardized clinical trial protocols and extended-term result assessments require large-scale evaluations in order to advance the field.
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Dalia Emara
Senior Specialist Registrar, Orthodontist at Dubai Health, Dubai, UAE
Budoor Bin Bahar
Senior Specialist Registrar, Orthodontist at Dubai Health, Dubai, UAE
Adonis Abu Kariem
Dental Intern in MBRU, Dubai, UAE
Muhammad Bin Umar
House Officer, School of Dentistry, Islamabad, Pakistan
Rimsha Shiraz
House Officer, HBS Medical and Dental College, Islamabad, Pakistan
Rabya Fiaz
House Officer, HBS Medical and Dental College, Islamabad, Pakistan
Naila Imtiaz Anjum
House Officer (BDS), Rawal Institute of Health Sciences (RIHS), Islamabad, Pakistan
Eman Haroon
House Officer (BDS), Rawal Institute of Health Sciences (RIHS), Islamabad, Pakistan
Syed Zain Ali Naqvi
Medical Officer (General Dentist), POF Hospital, Wah Cantt, Pakistan
Maham Naeem
House Officer, Foundation Dental Hospital, Islamabad, Pakistan