Oral and Functional Appliances for Childhood Sleep Apnoea (Cochrane Review)

Surgery to remove the adenoids and tonsils is the usual first move for childhood sleep apnoea, but it carries surgical risk and, in some children, the apnoea returns — often because the underlying craniofacial structure was never addressed. This Cochrane review, the most rigorous tier of evidence synthesis, examined a different class of treatment: oral appliances and functional orthopaedic appliances that work on the shape and position of the jaws.

The premise is structural. If a child's apnoea stems partly from how the jaws and airway are built, then a device that guides jaw growth or posture might help where surgery alone falls short. The review gathered and appraised the trials testing these appliances against that backdrop of surgical limitation and recurrence.

This matters because it links the airway directly to the architecture of the growing face — the heart of the "Space to Stand Well" idea that structure and breathing are inseparable. Treating sleep apnoea by reshaping growth, rather than only cutting away obstruction, reflects the project's emphasis on root causes over repeated downstream fixes.