Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review

Abstract Objective To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. Methods The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. Results We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. Conclusion Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.

Reliability of plantar pressure and postural control measures of children from 4 to 12 years: analysis by baropodometry

Abstract Aim: Baropodometry is used to map pressure areas and plantar pressure oscillation, however, children's evaluation reliability is not established. To establish the intra-rater and inter-rater reliability of baropodometry for analysis of plantar support and postural control (stabilometry) of children. Materials and Methods: Reliability study. The sample consisted of 112 healthy children of both sexes; aged 4 to 12 years old. For the baropodometer analysis, children were positioned in orthostatic position, bipodal support, with parallel and bare feet during four rounds of 15-second evaluations, executed by two independent evaluators. In order to establish the reliability of the results at different age ranges, participants were divided into two groups: children ages 7 years and younger (n = 44) and children aged 8 to 12 years old (n = 68). The variables analyzed were pressure area and maximum plantar pressure, area, and amplitude of oscillation of the center of pressure. Results: Reliability was rated from good to excellent for the intra- and inter-evaluators (ICC 0.81-0.86 and ICC 0.87-0.95, respectively) on plantar pressure variables, and poor to moderate for the center of pressure oscillations (ICC 0.33-0.55; ICC 0.47-0.57, intra and inter-evaluators, respectively). Conclusion: Excellent baropodometry reliability was observed when analyzing children's plantar pressure at different age groups, and a single evaluation established reliable results. However, the stabilometry analysis with a baropodometer has poor reliability, and therefore, it should not be used for children aged 4 to 12 for postural control.