Rapid maxillary expansion versus watchful waiting in pediatric OSA: A systematic review

Sleep Med Rev. 2022 Apr:62:101609. doi: 10.1016/j.smrv.2022.101609. Epub 2022 Feb 11.


Spontaneous resolution of pediatric obstructive sleep apnea (OSA) may stand behind the observed benefit of rapid maxillary expansion (RME), mainly supported by uncontrolled case series. We aimed to review the controlled, ideally randomized, evidence on the effectiveness of RME as compared to watchful waiting or alternative treatment of pediatric OSA. We only found one randomized clinical trial comparing RME with watchful waiting. The other four studies compared RME with the gold-standard treatment adenotonsillectomy, three of them in a non-randomized fashion. The results of the RCT showed no statistically significant differences in the enhancement of main (apnea hypopnea index, AHI) and secondary outcomes between RME and watchful waiting. Furthermore, reproducibility of the published studies was limited by insufficient description of their patients' inclusion criteria. We could not find convincing evidence of the benefit of RME over watchful waiting in patients with pediatric OSA. RCTs with reproducible inclusion criteria comparing RME with watchful waiting are still critically needed to support this intervention for the treatment of pediatric OSA. In the absence of solid evidence with RCT, RME should not be recommended for the treatment of pediatric OSA. PROSPERO REGISTRATION NUMBER: CRD42021249261. RUNNING SUMMARY: This systematic review explores the benefits of rapid maxillary expansion compared to spontaneous resolution of pediatric obstructive sleep apnea.

Keywords: Children; Natural history; Obstructive; Palatal expansion technique (MESH); Rapid maxillary expansion; Sleep apnea (MESH).

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adenoidectomy / methods
  • Child
  • Humans
  • Palatal Expansion Technique*
  • Randomized Controlled Trials as Topic
  • Reproducibility of Results
  • Sleep Apnea, Obstructive*
  • Watchful Waiting