Maxillary expansion and maxillomandibular expansion for adult OSA: A systematic review and meta-analysis

Objective: This study sought to systematically review the international literature for articles evaluating maxillary expansion and maxillomandibular expansion as treatments for obstructive sleep apnea (OSA) in adults and to perform a meta-analysis. Data sources: Nine databases (including MEDLINE/PubMed). Review methods: Searches were performed through January 8, 2016. The PRISMA statement was followed. Results: Eight adult studies (39 patients) reported polysomnography and/or sleepiness outcomes. Six studies reported outcomes for maxillary expansion (36 patients), and the apnea-hypopnea index (AHI) decreased from a mean (M) +/- standard deviation (SD) of 24.3 +/- 27.5 [95% CI 153, 33.3] to 9.9 +/- 13.7 [95% CI 5.4, 14.4] events/hr (relative reduction: 593%). Maxillary expansion improved lowest oxygen saturation (LSAT) from a M +/- SD of 84.3 +/- 8.1% [95% CI 81.7, 87.0] to 86.9 +/- 5.6% [95% CI 85.1, 88.7]. Maxillomandibular expansion was reported in two studies (3 patients) and AHI decreased from a M +/- SD of 47.53 +/- 29.81 [95% CI -26.5 to 121.5] to 10.7 +/- 3.2 [95% CI 2.8, 18.6] events/hr (relative reduction: 77.5%). Maxillomandibular expansion improved LSAT from a M SD of 76.7 +/- 14.5% [95% CI 40.7, 112.7] to 89.3 +/- 3.1 [95% CI 81.6, 97]. Conclusion: The current literature demonstrates that maxillary expansion can improve and maxillomandibular expansion can possibly improve AHI and LSAT in adults; however, given the paucity of studies, these remain open for additional research efforts. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.