Effect of rapid maxillary expansion on sleep apnea-hypopnea syndrome in growing patients. A meta-analysis

Abstract

BackgroundChanges produced in the upper airway after rapid maxillary expansion makes this procedure a therapeutic option for treating sleep apnea-hypopnea syndrome (SAHS) in children. The objective of this systematic review and meta-analysis was to analyze the evidence available for the effects of rapid maxillary expansion (RME) on SAHS, analyzing changes produced in oximetric variables: apnea-hypopnea index (AHI); oxygen saturation (SO2); sleep efficiency (SE), total sleep time (TST), percentage of rapid eye movement (REM) phase; and arousal index (AI).Material and MethodsAn electronic search was conducted in the PubMed, Scopus, Embase, and Cochrane databases, and in grey literature (Opengrey). No limit was placed on publication date or language. Inclusion criteria were: patients in growth with sleep apnea who underwent rapid maxillary expansion with oximetric values registered before and after treatment. Articles with patient sample sizes <10 were excluded. Ten articles were included for qualitative synthesis and nine for meta-analysis (eliminating one observational study).ResultsAHI values underwent a mean reduction of 5.79 events/hour (CI -95% 9.06 to 2.5); an increase in mean oxygen saturation of 2.54 % (CI-95% -0.28 to 4.80, 6.7 %); a reduction in AI of 2.17 events/hour (CI-95% -5.25 to -0.582); an increase in REM phase of 1.20 % (CI-95% 1.02 to 1.38); and an increase in SE of 0.961% (CI-95% -1.574 to 3.495).ConclusionsRME would appear efficient for treating slight or moderate SAHS, as indicated by improvement in oximetric parameters; it may be effective as coadjuvant therapy to adenotonsillectomy in severe cases of children with maxillary compression. Key words:Rapid maxillary expansion, obstructive sleep apnea.

Volumetric Changes in the Upper Airways after Rapid and Slow Maxillary Expansion in Growing Patients: A Case-Control Study

“…Several studies have already observed that orthopedic expansion of the maxilla also causes an increase of the rhino-pharynx, the nasal cavity, and the paranasal sinuses air volumes [8][9][10][11][12][13]. Radiographic assessment was originally performed using bidimensional radiographs, by lateral and postero-anterior cephalograms [14].…”

Pediatric Obstructive Sleep Apnea Syndrome: Emerging Evidence and Treatment Approach

“…The current available symptomatic or causative treatments for children suffering from OSAS include the following [ 14 ]: Lifestyle changes–in particular, weight loss in obese subjects Continuous positive airway pressure (CPAP): while the literature reports CPAP to be the golden standard treatment of OSAS in adults, in the pediatric population, it has been reported as useful only in (i) patients ineligible for surgery, (ii) patients awaiting surgery, (iii) patients with persistent disease after surgery, and (iv) patients with other diseases (i.e., Down syndrome and craniofacial anomalies). It is considered as a palliative treatment that causes discomfort in children, which mostly do not get used to and so become uncooperative [ 15 ]. Pharmacological agents.…”

“… Surgically assisted RME performed by maxillofacial surgeons and orthodontists in adult subjects, by surgical reopening of the median suture of the palate to obtain an orthopedic effect. Maxillomandibular advancement (MMA) maxillomandibular complex advancement in the sagittal plane can be performed surgically and it allows upper airway size and muscle tone increase (maxilla-facial relevance) [ 15 ]. …”

“…Maxillomandibular advancement (MMA) maxillomandibular complex advancement in the sagittal plane can be performed surgically and it allows upper airway size and muscle tone increase (maxilla-facial relevance) [ 15 ].…”

“…Recent studies show controversial evidence about the effectiveness of the various treatment options of OSAS. In fact, some authors report that, from high-quality research, there is no evidence supporting RME, surgical or nonsurgical assisted, and/or MMA treatment in OSA patients [ 15 ].…”