Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis.

The objective of this review was to evaluate the effect of mandibular advancement appliances (MAAs) for obstructive sleep apnea (OSA) in children. To this end, several electronic databases (PubMed, EMBASE, Cochrane Library) were systematically searched until 18 June 2018. Randomized and non-randomized clinical trials were included. Articles of high-quality were included for the meta-analysis. Data extraction and quality assessment were conducted by two independent reviewers. Four randomized controlled trials (RCTs) and three non-RCTs were finally included in the review; of these, two RCTs of high-quality were included in the meta-analysis. The mean difference in apnea-hypopnea index (AHI) change for mandibular advancement group compared with control group was -1.75 events/h (95% confidence interval (CI) -2.07, -1.44), p < 0.00001. Sensitivity analysis including the quasi-randomized RCT and non-RCTs showed stable favorable results for MAAs. The meta-analysis showed supportive evidence for MAA treatment in pediatric OSA patients. Subgroup analysis suggested that MAA can be effective for mild to severe patients before the end of the pubertal peak. Long-term treatment (at least six months) may be more effective than short-term treatment.