Pediatric Obstructive Sleep Apnea: The Role of Orthodontic Management - Review Article

2021 ◽  
Vol 104 (2) ◽  
pp. 326-336
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Orthodontic Treatment ◽  
Treatment Success ◽  
Rapid Maxillary Expansion ◽  
Management Approach ◽  
Maxillary Expansion ◽  
Adenotonsillar Hypertrophy ◽  
Obstructive Sleep ◽  
Mandibular Retrognathia

Pediatric obstructive sleep apnea (OSA) is a common breathing-related sleep disorder affecting 1% to 5% of children. It often presents with less recognized signs and symptoms compared to adult OSA. Consequently, many patients with pediatric OSA remain undiagnosed. Risk factors include adenotonsillar hypertrophy, craniofacial anomalies, retrognathia, nasal obstruction, macroglossia, nasal septal deviation, and obesity. Orthodontist as a healthcare provider could have a significant role in screening, diagnostic referral, and treatment. The management approach for pediatric OSA requires multidisciplinary collaboration to obtain an optimal treatment outcome. Currently, adenotonsillectomy is recommended as first-line therapy. However, the treatment success varies considerably among patients. Children with OSA are often found to have narrow and constricted maxilla, mandibular retrognathia, and posterior rotation of mandible. Therefore, orthodontic treatment such as rapid maxillary expansion (RME), functional jaw orthopedic appliances, and protraction facemask could improve pediatric OSA with proper case selections. Additional maxillary expansion can also be performed in conjunction with adenotonsillectomy regardless of treatment sequence. The present article reviewed the currently available literature on the efficacy of various orthodontic treatments on pediatric OSA. Additional high-quality evidence is required to further substantiate the effectiveness of these orthodontic therapy. Keywords: Pediatric OSA, Orthodontic treatment, Rapid Maxillary Expansion (RME), Functional jaw orthopedic appliances, Protraction facemask

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.

Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis

2016 ◽  
Vol 127 (7) ◽  
pp. 1712-1719 ◽  
Author(s):  
Macario Camacho ◽  
Edward T. Chang ◽  
Sungjin A. Song ◽  
Jose Abdullatif ◽  
Soroush Zaghi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Rapid Maxillary Expansion ◽  
Maxillary Expansion ◽  
Obstructive Sleep

scholarly journals Efficacy of Rapid Maxillary Expansion with or without Previous Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome Based on Polysomnographic Data: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 10 (18) ◽  
pp. 6485
Author(s):  
Vincenzo Quinzi ◽  
Sabina Saccomanno ◽  
Rebecca Jewel Manenti ◽  
Silvia Giancaspro ◽  
Licia Coceani Paskay ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Meta Analysis ◽  
Sleep Apnea Syndrome ◽  
Rapid Maxillary Expansion ◽  
Maxillary Expansion ◽  
Obstructive Sleep ◽  
Before And After ◽  
Apnea Syndrome

Aim: To systematically review international literature related to rapid maxillary expansion (RME) as the treatment for obstructive sleep apnea syndrome (OSAS) in children less than 18 years-old, followed by a meta-analysis of the apnea-hypopnea index (AHI) before and after RME, with or without a previous adenotonsillectomy (AT). Methods: Literature on databases from PubMed, Wiley online library, Cochrane Clinical Trials Register, Springer link, and Science Direct were analyzed up to March 2020. Two independent reviewers (S.G. and R.J.M.) screened, assessed, and extracted the quality of the publications. A meta-analysis was performed to compare AHI values before and after the treatment with RME. Results: Six studies reported outcomes for 102 children with a narrow maxillary arch suffering from OSAS with a mean age of 6.7 ± 1.3. AHI improved from a M ± SD of 7.5 ± 3.2/h to 2.5 ± 2.6/h. A higher AHI change in patients with no tonsils (83.4%) and small tonsils (97.7%) was detected when compared to children with large tonsils (56.4%). Data was analyzed based on a follow-up duration of ≤3 year in 79 children and >3 years in 23 children. Conclusion: Reduction in the AHI was detected in all 102 children with OSAS that underwent RME treatment, with or without an adenotonsillectomy. Additionally, a larger reduction in the AHI was observed in children with small tonsils or no tonsils. A general improvement on the daytime and nighttime symptoms of OSAS after RME therapy was noted in all the studies, demonstrating the efficacy of this therapy.

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.

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