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Meta-Analysis
. 2025 Mar;172(3):759-773.
doi: 10.1002/ohn.1021. Epub 2024 Oct 19.

Management of Obstructive Sleep Apnea in the Infant: A Systematic Review and Meta-analysis

James A Leonard  1 , Daniel L Blumenthal  2   3 , Mohamad M Almasri  3 , Habib Zalzal  1   4 , Charles A Riley  5   6 , Claire M Lawlor  7   8
Affiliations
Meta-Analysis

Management of Obstructive Sleep Apnea in the Infant: A Systematic Review and Meta-analysis

James A Leonard et al. Otolaryngol Head Neck Surg. 2025 Mar.

Abstract

Objective: To evaluate the improvement in respiratory parameters of infants with obstructive sleep apnea (OSA) treated with medical or surgical intervention.

Data sources: A comprehensive review was completed using the PubMed, Web of Science, Embase, and Cochrane libraries including articles published from 1975 to 2024.

Review methods: Interventions studied included adenotonsillectomy, mandibular distraction osteogenesis (MDO), tongue/lip adhesion, partial glossectomy, floor-of-mouth release, supraglottoplasty, oral appliances, tracheostomy, and positioning. Continuous positive airway pressure (CPAP) served as a control. Outcomes studied included pre- and postintervention obstructive apnea-hypopnea index. Studies included randomized controlled trials and case-control trials. A total of 2161 records were identified, and 59 studies were included in the analysis. Data was extracted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and pooled using a random-effects model. The primary study outcome established prior to data collection was a change in the apnea-hypopnea index.

Results: A meta-analysis of MDO performed in infants for OSA demonstrated an overall pooled mean difference (pre-apnea-hypopnea index minus post-apnea hypopnea index) of 30.1 (95% confidence interval: 22.9, 37.4; 10 studies, 373 patients). No other data was pooled for analysis due to study heterogeneity. All CPAP studies showed apnea resolution. Tailored therapies including supraglottoplasty and tongue-lip adhesion reduced but did not resolve apneic events.

Conclusion: Current investigations of the evaluation and treatment of infant OSA are limited by heterogeneity in reporting and study. Mandibular distraction and CPAP are promising.

Keywords: infant; mandibular distraction osteogenesis; obstructive sleep apnea.

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References

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