Raheesa Abdurahman, Dilshad Umar, Shafees Koya, Sandeep Shetty
MARPE seems an efficient nonsurgical treatment of OSA in patients with maxillary constriction. It provides significant changes in AHI and airway volume, and the risk of complications is low. These findings have to be validated in larger and long-term trials.
BACKGROUND: Obstructive sleep apnea (OSA) is a common disease that is characterized by collapse of the upper airway during sleep. In some phenotypes, airway obstruction is due to maxillary transverse deficiency. Structural intervention miniscrew-assisted rapid palatal expansion (MARPE) has been proposed as a way to enhance airway patency.
OBJECTIVE: To assess the effectiveness of MARPE in the reduction of OSA severity and the improvement of the upper airway dimensions in the pediatric and adult populations in a systematic way.
METHODS: This study performed a systematic review and meta-analysis that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search of 6 databases was conducted to find studies that evaluated MARPE in patients with OSA. RoBANS 2 was applied to assess risk of bias, and quantitative synthesis was done on apnea-hypopnea index (AHI) using a random-effects model.
RESULTS: A total of 10 of the studies were included (n = 412). MARPE was linked to a pooled AHI decrease of 5.46 events/hour (95% CI: 6.01-4.90). There were substantial volumetric airway enlargements in nasal and nasopharyngeal areas. Appliances that are bone-borne resulted in more skeletal changes in comparison to those that are tooth-borne expanders. Adverse events were few.
CONCLUSION: MARPE seems an efficient nonsurgical treatment of OSA in patients with maxillary constriction. It provides significant changes in AHI and airway volume, and the risk of complications is low. These findings have to be validated in larger and long-term trials.