The effects of mandibular advancement devices on pediatric obstructive sleep apnea: An umbrella review

This umbrella review evaluated the effects of mandibular advancement devices (MADs) on pediatric obstructive sleep apnea (PedOSA). We searched six databases for systematic reviews published up to June 2025, that included children with polysomnography (PSG)-diagnosed OSA managed with MADs. The primary outcome was the change in the apnea-hypopnea index (AHI). Secondary outcomes included oxygen saturation and skeletal/dental changes. Twelve systematic reviews, including 7 meta-analyses, were included. Management with MADs resulted in a reduction in AHI and a slight improvement in sagittal mandibular position. However, significant heterogeneity was observed due to variations in device designs, treatment duration, and patient characteristics. Most findings were based on before-after studies, with limited randomized controlled trials, reducing the robustness of the results. The methodological quality of the included systematic reviews, assessed using AMSTAR 2, was predominantly low or critically low, indicating significant flaws. A corrected covered area (CCA) analysis revealed substantial overlap (20.7 %) in primary studies. While MADs show promise as an adjunctive therapy for PedOSA management in indicated cases, the low methodological quality of the included systematic reviews limits the strength of the evidence. High-quality primary studies and systematic reviews are needed to confirm the impact of MADs in PedOSA management and guide clinical practice.