scholarly journals Evaluation of the Effects of Different Rapid Maxillary Expansion Appliances on Obstructive Sleep Apnea: A randomized clinical trial

2021 ◽  
Author(s):  
Gokcenur Gokce ◽  
Ozen K Basoglu ◽  
Ilknur Veli
Keyword(s):  
Clinical Trial ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Randomized Clinical Trial ◽  
Rapid Maxillary Expansion ◽  
Secondary Outcome ◽  
Apnea Hypopnea Index ◽  
Maxillary Expansion ◽  
Obstructive Sleep ◽  
Tooth Tissue

Purpose The aim of this randomized clinical trial was to evaluate the effects of tooth tissue-borne (TTB), tooth-borne (TB), and bone-borne (BB) rapid maxillary expansion appliances on obstructive sleep apnea (OSA) severity. Trial design Three-arm parallel randomized controlled trial. Methods This study was designed in parallel with an allocation ratio of 1:1:1. Forty six patients with narrow maxilla and diagnosis of OSA recruited from the Department of Orthodontics, ### University were randomly assigned to three groups according to appliance used: tooth tissue-borne, tooth-borne and bone-borne expanders. The primary outcome of this study included polygraphic change in sleep parameters. Secondary outcome was the correction of posterior crossbite. Each subject underwent overnight sleep test with polygraphy at baseline and 3 month-follow-up of treatment. Randomization was performed using a computer-generated randomization program The outcome assessor was blinded to group assignment. For the statistical analysis, Kruskal-Wallis analysis and Dunn-Bonferroni tests were used for inter-group comparisons and Wilcoxon analysis was used for intra-group evalaution. p<0.05 was accepted statistically significant. Results The amount of expansion in maxillary width and upper intermolar width were similar in all goups (95% confidence interval [CI], p>0.05). The groups were similar in terms of apnea-hypopnea index (AHI) and oxygen saturation parameters at baseline (95% [CI], p>0.05). After 3 months of treatment, there was no significant decrease in AHI and oxygen desaturation index, and no increase in minimum and mean oxygen saturations (95% [CI], p>0.05). Supine AHI values were decreased by the tooth tissue-borne and tooth-borne appliances, but these changes were not significant (95% [CI], p>0.05). Harms No serious harm ocurred except mild gingivitis. Conclusions Similar skeletal and dental expansion of maxilla were observed after RME with all expanders. Although the decrease in AHI was not significant, RME can be used as an adjunct to the primary treatment in OSA patients.

562 Adenoid Regrowth after Rapid Maxillary Expansion in Residual Pediatric OSA: Interim analysis of ERMES Randomized Clinical Trial

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A222-A222
Author(s):  
Marcos Fernández-Barriales ◽  
Montserrat López de Luzuriaga ◽  
Ainoa Álvarez ◽  
Lourdes Guerra ◽  
Jose Manuel Aguirre-Urizar ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oral Cavity ◽  
Randomized Clinical Trial ◽  
Population Based ◽  
Rapid Maxillary Expansion ◽  
Apnea Hypopnea Index ◽  
Maxillary Expansion ◽  
Obstructive Sleep

Abstract Introduction Residual pediatric Obstructive Sleep Apnea (OSA) after gold-standard treatment with adenotonsillectomy occurs in nearly 20% of the patients. Treatment alternatives are scarce and based upon low-level evidence. Rapid maxillary expansion is an orthodontic-orthopaedic treatment of maxillary transverse hypoplasia that has shown promising results in pediatric OSA based upon nasal and oral cavity enlargement. Revision adenoidectomy of all-purpose adenotonsillectomies in population-based studies is 4,9%, and a three-fold risk in OSA patients has been reported. We present data from an ongoing randomized clinical trial (ERMES) highlighting the importance of nasofibroscopic control of the adenoid tissue in residual pediatric OSA patients. Methods According to the study protocol of our ongoing randomized clinical trial (Rapid maxillary expansion for treatment of residual pediatric obstructive sleep apnea; Acronym: ERMES; NCT02947464) patients aged 4 to 9 years old with polysomnographic evidence of OSA persistence after adenotonsillectomy were randomized to either rapid maxillary expansion or wahtchful waiting. They underwent fiberoptic nasopharingoscopy in order to stablish the amount of adenoidal tissue present at the time of inclusion and at polysomnographic control twelve months later. The nasopharyngeal occupation was measured in a 1 to 4 scale. Patients that graded 3 or 4 at the initial nasofibroscopy were excluded from the study due to their surgical revision indication; if they developed grade 3 or 4 adenoid hypertrophy and persistence of symptoms at the final assesment they were offered re-adenoidectomy. Results A total of 5 patients developed an adenoid regrowth amenable for revision surgery: 4 of them within the rapid maxillary expansion group and one in the watchful waiting group. All of them had experienced either worsening or very mild improvement in their apnea hypopnea index (AHI). Conclusion Adenoid regrowth is a known risk factor for pediatric OSA persistence. The anatomical enlargement of the nasal and oral cavity provided by means of rapid maxillary expansion may trigger such overgrowth in otherwise predisposed residual OSA patients. Fiberoptic nasopharyngoscopy is therefore mandatory in the follow-up of such complex cases, since adenoid regrowth may hinder resolution of OSA and its associated symptoms. Support (if any) ERMES Randomized Clincal Trial (NCT02947464) is funded by Departamento de Salud del Gobierno Vasco.

The effect of adenotonsillectomy and rapid maxillary expansion on the upper airway in pediatric obstructive sleep apnea: a randomized crossover-controlled trial

SLEEP ◽  
2021 ◽  
Author(s):  
Maria Cecilia Magalhães ◽  
Carlos José Soares ◽  
Eustáquio A Araújo ◽  
Gabriela de Rezende Barbosa ◽  
Ricardo Maurício O Novaes ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Rapid Maxillary Expansion ◽  
Wilcoxon Test ◽  
Apnea Hypopnea Index ◽  
Marginal Effect ◽  
Maxillary Expansion ◽  
Obstructive Sleep ◽  
Group Comparisons

Abstract Study Objectives We aimed to determine the effects of adenotonsillectomy (AT) and rapid maxillary expansion (RME) on the apnea-hypopnea index (AHI) and compare volumetric changes in the upper airway (UA) arising from AT and RME. Methods Thirty-nine children who presented with maxillary constriction and grade III/IV tonsillar hypertrophy were randomized into two groups. One group underwent AT as the first treatment, and the other group underwent RME. Polysomnography (PSG) and cone-beam computed tomography (CBCT) were conducted before (T0) and 6 months after the first treatment (T1). In a crossover design, individuals with AHI&gt;1 received the second treatment. Six months later, they underwent PSG and CBCT (T2). The influence of age, sex, tonsil and adenoid hypertrophy, initial AHI severity, initial volume of the UA, first treatment, and maxillary expansion amount was evaluated using linear regression analysis. Intra- and inter-group comparisons for AHI and inter-group comparisons of volumetric changes in each region of the UA were performed using a paired t-test and Wilcoxon test. Results The initial AHI severity and therapeutic sequence in which AT was the first treatment explained for 95.6% of AHI improvement. AT caused significant improvements in the AHI and volumetric increases in the buccopharynx and total UA areas compared to RME. Conclusions The initial AHI severity and AT as the first treatment accounted for most of the AHI improvement. Most reductions in AHI were due to AT, which promoted more volumetric increases in UA areas than RME. RME may have a marginal effect on pediatric obstructive sleep apnea.

scholarly journals Effects of a Combined Community Exercise Program in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial

2019 ◽  
Vol 8 (3) ◽  
pp. 361 ◽  
Author(s):  
Rodrigo Torres-Castro ◽  
Jordi Vilaró ◽  
Joan-Daniel Martí ◽  
Onintza Garmendia ◽  
Elena Gimeno-Santos ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Randomized Clinical Trial ◽  
Exercise Program ◽  
Walking Distance ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep

Physical activity is associated with a decreased prevalence of obstructive sleep apnea and improved sleep efficiency. Studies on the effects of a comprehensive exercise program in a community setting remain limited. Our objective was to investigate the effects of a combined physical and oropharyngeal exercise program on the apnea-hypopnea index in patients with moderate to severe obstructive sleep apnea. This was a randomized clinical trial where the intervention group followed an eight-week urban-walking program, oropharyngeal exercises, and diet and sleep recommendations. The control group followed diet and sleep recommendations. A total of 33 patients were enrolled and randomized and, finally, 27 patients were included in the study (IG, 14; CG, 13) Obstructive sleep apnea patients were analyzed with a median age of 67 (52–74) and median apnea-hypopnea index of 32 events/h (25–41). The apnea-hypopnea index did not differ between groups pre- and post-intervention. However, in intervention patients younger than 60 (n = 6) a reduction of the apnea-hypopnea index from 29.5 (21.8–48.3) to 15.5 (11–34) events/h (p = 0.028) was observed. While a comprehensive multimodal program does not modify the apnea-hypopnea index, it could reduce body weight and increase the walking distance of patients with moderate to severe obstructive sleep apnea. Patients younger than 60 may also present a decreased apnea-hypopnea index after intervention.

Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up

2007 ◽  
Vol 8 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Maria Pia Villa ◽  
Caterina Malagola ◽  
Jacopo Pagani ◽  
Marilisa Montesano ◽  
Alessandra Rizzoli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Rapid Maxillary Expansion ◽  
Maxillary Expansion ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Rapid Maxillary Expansion in Obstructive Sleep Apnea in Young Patients: Cardio-Respiratory Monitoring

2017 ◽  
Vol 41 (4) ◽  
pp. 312-316 ◽  
Author(s):  
Alfio Buccheri ◽  
Fabio Chinè ◽  
Giovanni Fratto ◽  
Licia Manzon
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Young Patients ◽  
Rapid Maxillary Expansion ◽  
Respiratory Monitoring ◽  
Respiratory Disorder ◽  
Maxillary Expansion ◽  
Mean Values ◽  
Obstructive Sleep ◽  
The Mean

Objective(s): Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder which affects from 1 to 3 % of people during development. OSAS treatment may be pharmacological, surgical or based on application of intraoral devices to increase nasal respiratory spaces. The purpose of this study was to determine the efficacy of the Rapid Maxillary Expander in OSAS young patients by measuring cardio-respiratory monitoring parameters (AHI, the average value of complete and incomplete obstructed respiration per hour of sleep, and SAO2, the percentage of oxygen saturation). Study design: The study was conducted on 11 OSAS young subjects (mean age 6.9±1.04 years), all treated with rapid maxillary expansion (RME). Cardio-respiratory monitoring (8-channel Polymesam) was performed at the beginning (diagnostic, T0) and after 12 months of treatment. Results: The mean values of cardio-respiratory parameters at TO were: AHI=6.09±3.47; SAO2=93.09%±1.60. After 12 months of treatment, the mean values of the same polysomnographic parameters were: AHI=2.36 ± 2.24;SAO2=96.81% ±1.60. These changes were associated with an improvement in clinical symptoms, such as reduction of snoring and sleep apnea. Conclusion(s): This study confirms the therapeutic efficacy of RME in OSAS young patients. This orthopedic-orthodontic treatment may represent a good option in young patients affected by this syndrome.

scholarly journals A Comparison of Uvulopalatopharyngoplasty and Modified Radiofrequency Tissue Ablation in Mild to Moderate Obstructive Sleep Apnea: A Randomized Clinical Trial

2017 ◽  
Vol 13 (09) ◽  
pp. 1089-1096 ◽  
Author(s):  
Amin Amali ◽  
Maziar Motiee-Langroudi ◽  
Babak Saedi ◽  
Sara Rahavi-Ezabadi ◽  
Ali Karimian ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Randomized Clinical Trial ◽  
Tissue Ablation ◽  
Obstructive Sleep

Postoperative Changes in Sleep-disordered Breathing and Sleep Architecture in Patients with Obstructive Sleep Apnea

2014 ◽  
Vol 120 (2) ◽  
pp. 287-298 ◽  
Author(s):  
Frances Chung ◽  
Pu Liao ◽  
Balaji Yegneswaran ◽  
Colin M. Shapiro ◽  
Weimin Kang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Slow Wave Sleep ◽  
Sleep Architecture ◽  
Secondary Outcome ◽  
Apnea Hypopnea Index ◽  
Postoperative Changes ◽  
Obstructive Sleep ◽  
Disordered Breathing

Abstract Background: Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these parameters than patients without OSA. Methods: After obtaining approvals from the Institutional Review Boards, consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital. The primary and secondary outcome measurements were polysomnographic parameters of sleep-disordered breathing and sleep architecture. Results: Of the 58 patients completed the study, 38 patients had OSA (apnea hypopnea index [AHI] &gt;5) with median preoperative AHI of 18 events per hour and 20 non-OSA patients had median preoperative AHI of 2. AHI was increased after surgery in both OSA and non-OSA patients (P &lt; 0.05), with peak increase on postoperative N3 (OSA vs. non-OSA, 29 [14, 57] vs. 8 [2, 18], median [25th, 75th percentile], P &lt; 0.05). Hypopnea index accounted for 72% of the postoperative increase in AHI. The central apnea index was low (median = 0) but was significantly increased on postoperative N1 in only non-OSA patients. Sleep efficiency, rapid eye movement sleep, and slow-wave sleep were decreased on N1 in both groups, with gradual recovery. Conclusions: Postoperatively, sleep architecture was disturbed and AHI was increased in both OSA and non-OSA patients. Although the disturbances in sleep architecture were greatest on postoperative N1, breathing disturbances during sleep were greatest on postoperative N3.

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