Maxillary Expansion for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

Introduction: Obstructive sleep apnea (OSA) is a disorder that is characterized by a partial or total obstruction of the upper airways during sleep and is associated with significant implications for cardiovascular and psychological health, quality of life, and driving safety. This study systematically reviewed international literature assessing the efficacy of isolated maxillary expansion as a treatment for OSA in adults.

Methods: Database searches were conducted up to November 2023 in Pubmed and Embase, adhering to Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extraction and analysis, risk of bias assessment, quality of evidence evaluation, and meta-analyses were conducted.

Results: Initial electronic searches yielded 437 studies. After applying the inclusion criteria, 52 articles were screened, and 19 studies were included. The final pooled data included 360 patients with a mean age of 35.53 ± 12.24 years. Most patients were male (69.8%) with an average BMI of 27.82 ± 4.17. Most studies used either microimplant assisted rapid palatal expansion (MARPE) or surgically assisted rapid palatal expansion (SARPE) (n=14) as their maxillary expansion technique. Meta-analysis showed a statistically significant mean difference (MD) improvement for Apnea-Hypopnea Index (AHI) (MD = -12.37, SD = ± 5.43), Epworth Sleepiness Scale (ESS) (MD = -4.85, SD = ± 0.91), Oxygen Desaturation Index (ODI) (MD = -8.39, SD = ± 4.61), and mean Lowest Oxygen Saturation (LSAT) (MD = -2.88, SD ± 0.89).

Conclusions: The results from this study suggest that isolated maxillary expansion is an effective treatment in adult OSA patients. However, surgeons must carefully select patients and address the appropriate underlying anatomical and functional anomalies of the airway.