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Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children

  • Review
  • Intervention

Authors


Abstract

Background

Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adenotonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbidities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they change the mandible posture forwards and potentially enlarge the upper airway and increase the upper airspace, improving the respiratory function.

Objectives

To assess the effectiveness of oral appliances or functional orthopaedic appliances for OSAS in children.

Search methods

A sensitive search was developed for the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); PubMed (January 1966 to September 2005); EMBASE (1980 to September 2005); LILACS (1982 to September 2005); BBO (1986 to September 2005); and SciELO (1997 to September 2005).
There was no restriction of language or source of information.

Selection criteria

All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger. Primary outcome: reduction of apnoea to less than one episode per hour. Secondary outcomes: dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiologic function, behavioural problems, drop outs and withdrawals, quality of life, side effects (tolerability), economic evaluation.

Data collection and analysis

Data were independently extracted by two review authors. Authors were contacted for additional information. Risk ratios with 95% confidence intervals were calculated for all important dichotomous outcomes.

Main results

The initial search identified 384 trials. One of them, reporting results from a total of 23 patients, was suitable for inclusion in the review. Data provided in the published report did not answer all the questions from this review, but some of them were, and the presented results favour treatment.

Authors' conclusions

At present there is no sufficient evidence to state that oral appliances or functional orthopaedic appliances are effective in the treatment of OSAS in children. Oral appliances or functional orthopaedic appliances may be helpful in the treatment of children with craniofacial anomalies which are risk factors for apnoea.

摘要

背景

口內裝置和功能性整骨裝置應用在孩童阻塞性睡眠呼吸終止症

呼吸暫停是一種在鼻或口缺少空氣流通的呼吸失調。在孩童中,有扁桃體腺樣體肥大、肥胖、神經肌肉系統失調、顱顏面異常者有較高的風險。在孩童時期,最普遍的阻塞性睡眠呼吸終止症(OSAS)治療方式是腺樣體扁桃體切除術。這個方法會受手術風險所限制,大部分是有肥胖疾病(comorbities)的孩童、及有些病人因顱顏面相關問題引起的復發。口內裝置和功能性整骨裝置已經使用在有阻塞性睡眠呼吸終止症和顱顏面異常的患者,因為可以使下顎的位置往前移,可能會加大上呼吸道和增加上空腔,以增加呼吸功能。

目標

為了評估在有阻塞性睡眠呼吸終止症的孩童中使用口內裝置或功能性整骨裝置的效果。

搜尋策略

審慎的搜尋Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3), PubMed(January 1966 to September 2005);EMBASE(1980 to September 2005);Lilacs(1982 to September 2005);BBOBibliografia Brasileira de Odontologia(1986 to September 2005);and SciELO(1997 to September 2005)。並且沒有語言或資訊來源的限制。

選擇標準

針對15歲以下兒童,所有隨機或類隨機控制試驗,比較所有口內和功能性整骨裝置與使用安慰裝置或無治療的效果。 主要的結果是減少呼吸終止症至一小時少於一次,次要的結果包含牙齒和骨骼的關係、睡眠參數增加、認知和語言聽力的功能、行為的問題、輟學和退縮、生活品質、副作用(耐受性);經濟上的評估。

資料收集與分析

數據由兩位作者獨立地取得。會連繫作者以獲得更多的資訊。對所有重要的二分結果,計算百分之九十五信賴區間的風險值。

主要結論

初始搜尋找到384個試驗。其中一篇有關23位患者的研究,符合本回顧的收錄。由已發表報告所得的資料無法回答本回顧所有的問題,但結果多少認為治療是可行的。

作者結論

目前並沒有充足的證據顯示口內裝置或功能性整骨裝置對於孩童的阻塞性睡眠呼吸終止症是有效率了。口內裝置或功能性整骨裝置可能對於有顱顏面異常而導致呼吸終止者的治療有幫助。

翻譯人

本摘要由臺灣大學附設醫院趙書瑩翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

孩童的阻塞性睡眠呼吸終止症,使用口內裝置或功能性整骨裝置的治療是合適的。然而,這只有根據一個小研究的數據。最常用來治療孩童的阻塞性睡眠呼吸終止症是腺樣體扁桃體切除術。這個方法會受顱顏面問題的復發所限制。口內裝置或功能性整骨裝置已經被用在有阻塞性睡眠呼吸終止症及顱顏面異常的病人,因為他們使下顎的位置往前和可能會增加上呼吸道、增加呼吸功能。目前,仍沒有足夠的證據來證明口內裝置或功能性整骨裝置對於孩童的阻塞性睡眠呼吸終止症是有效率的。

Plain language summary

Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children

Treatment of obstructive sleep apnoea syndrome (OSAS) in children appears to be possible with oral appliances or functional orthopaedic appliances. However this is only based on data from one small study.
The common treatment for OSAS in childhood is adenotonsillectomy. This approach is limited by recurrence that can be associated with craniofacial problems. Oral/functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they change mandible posture forwards and potentially increase the upper airway, improving the respiratory function. At present there is no sufficient evidence to affirm that oral/functional orthopaedic appliances are effective in the treatment of OSAS in children.

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