Efficacy of the twin-block appliance for pediatric obstructive sleep apnea: an updated systematic review and meta-analysis
Abstract
To provide an updated and robust assessment of the efficacy of the Twin-Block appliance in the treatment of pediatric obstructive sleep apnea (OSA). A previous meta-analysis indicated a potential benefit, but was limited by the quality of available evidence and is now outdated. This study aims to synthesize all current evidence, including recent high-quality randomized controlled trials (RCTs). This systematic review and meta-analysis was conducted following PRISMA guidelines. A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was performed up to October 2025. We included RCTs, non-randomized controlled trials (NRCTs), and case series evaluating the effect of the Twin-Block appliance on respiratory parameters in children (< 18 years) with OSA. The primary outcome was the change in the Apnea-Hypopnea Index (AHI). A random-effects model was used to calculate the pooled Mean Difference (MD) and 95% Confidence Intervals (CIs). Sensitivity analyses were performed, and the risk of bias was assessed using design-specific tools (RoB 2, ROBINS-I, and the JBI Critical Appraisal Checklist). Eight studies, comprising a total of 259 patients, were included in the systematic review. The meta-analysis of seven studies (n = 219) demonstrated that Twin-Block therapy resulted in a statistically significant and clinically meaningful reduction in AHI (pooled MD: -6.68, 95% CI: -8.76 to -4.60; p < 0.0001). Significant heterogeneity was observed across studies (I² =…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 259 participants or records.
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