Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis

Laryngoscope. 2017 Jul;127(7):1712-1719. doi: 10.1002/lary.26352. Epub 2016 Oct 31.


Objectives/hypothesis: To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA).

Data sources: PubMed/MEDLINE and eight additional databases.

Review methods: Three authors independently and systematically reviewed the international literature through February 21, 2016.

Results: Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea-hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is -1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73-95% reduction) than in children with large tonsils (61% reduction). For >3-year follow-up (range = 6.5-12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction).

Conclusions: Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up). Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope, 2016 Laryngoscope, 127:1712-1719, 2017.

Keywords: Obstructive sleep apnea; meta-analysis; sleep apnea; sleep medicine; systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adenoidectomy
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Oxygen / blood
  • Palatal Expansion Technique*
  • Postoperative Complications / blood
  • Postoperative Complications / diagnosis
  • Sleep Apnea, Obstructive / blood
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / surgery*
  • Tonsillectomy


  • Oxygen