Maxillary Expansion and Maxillomandibular Expansion for Adult OSA: A Systematic Review and Meta-Analysis

Abstract 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 15.3, 33.3] to 9.9±13.7 [95% CI 5.4, 14.4] events/hr (relative reduction: 59.3%). 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.