The effect of rapid maxillary expansion on children with obstructive sleep apnea: a systematic review and meta-analysis.

PURPOSE: Pediatric obstructive sleep apnea (OSA) is a respiratory disorder that may lead to significant neurocognitive, behavioral, and cardiovascular dysfunction. Studies show rapid maxillary expansion (RME) widens the maxilla and nasal cavity, potentially reducing OSA symptoms. This systematic review and meta-analysis summarized recent the international literature on the efficacy of RME in alleviating pediatric OSA.

METHODS

Adhering to PRISMA guidelines and PROSPERO registration, we searched five databases (including PubMed and Embase) through March 2025. We included randomized and non-randomized studies assessing RME in children with PSG-diagnosed OSA. Risk of bias was evaluated using ROBINS-I, and evidence certainty via GRADE. Random-effects meta-analyses were performed for respiratory and radiological outcomes.

RESULTS

Meta-analyses performed with RevMan software (version 5.4) revealed that the apnea-hypopnea index (AHI) decreased within six months following the completion of active RME (MD: -4.04, 95% CI: -6.39 to -1.70, P = 0.0007, I² = 93%) and within twelve months (MD: -6.15, 95% CI: -11.66 to -0.64, P = 0.03, I² = 97%). Additionally, a significant reduction in the Arousal Index was observed following maxillary expansion, while peripheral capillary oxygen saturation (SpO2%), total sleep time (TST), the lowest peripheral capillary oxygen saturation (Lowest SpO2%), and maxillary width demonstrated significant improvements at various time points after RME treatment.

CONCLUSIONS

Based on the current evidence and its inherent limitations, these findings indicated that RME can effectively enhance the transverse width of the maxilla and improve polysomnographic parameters in pediatric patients with OSA. REGISTRATION: PROSPERO (CRD42025631528).