Mini-implant assisted rapid palatal expansion (MARPE) effects on adult obstructive sleep apnea (OSA) and quality of life: a multi-center prospective controlled trial

Abstract

Introduction Transverse maxillary deficiency is a high prevalent growth disorder within the adult population that may lead to serious health issues, such as detrimental malocclusions and higher risk of developing obstructive sleep apnea (OSA). Mini-implant assisted rapid palatal expansion (MARPE), as it expands the mid-face and augment the nasal and oral cavities dimensions, may reduce the airflow resistance and thus play an important role on OSA therapy in some patients. The main objective of the present trial is to assess MARPE effects on the sleep and quality of life of non-obese adult OSA patients with transverse maxillary deficiency. Methods A total of 32 participants were divided into intervention and control groups. They underwent physical evaluation, Epworth Sleepiness Scale (EES) and Quebec Sleep Questionnaire (QSQ), cone-beam computed tomography (CBCT) and home sleep testing (HST) for OSA before MARPE (T1) and 6 months after the intervention (T2). Results Questionnaires EES (daytime sleepiness) and QSQ (OSA-related quality of life) presented significant statistical differences between the groups. We also found clinical and statistical (p < 0.01) differences between the groups regarding the apnea/hypopnea index (AHI), as well as others HST parameters (mean oxygen saturation and snoring duration). Conclusion In our sample, MARPE (without any auxiliary osteotomy) showed a good success rate (85%) and promoted important occlusal and respiratory benefits. We observed important daytime sleepiness and OSA-related quality of life improvement, as well as the AHI (65.3%), oxygen saturation and snoring duration.

Dimensional changes of upper airway after slow vs rapid miniscrew-supported maxillary expansion in adolescents: a cone-beam computed tomography study

“…Clinically, increasing the dimensions of the airway may alter the patients’ respiration [ 7 , 9 , 13 ]. Moreover, it may alleviate breathing disorders [ 30 ]. Linear parameters, cross-sectional area and volume of the airway were measured on CBCT to provide a complete evaluation of the upper airway [ 31 ].…”

Obstructive sleep apnea: a review for the orthodontist

“… 83 Li et al 84 also found volumetric increase only in the nasal cavity and nasopharynx after treatment of maxillary constriction with MARPE. Brunetto et al 85 evaluated 20 patients (>18 years) with transverse maxillary deficiency treated with MARPE and compared them with a control group of 12 untreated patients with matched characteristics.The MARPE-treated group showed significant respiratory improvement, with a mean reduction of 65.3% in AHI and self-reported improvement (Epworth Sleepiness Scale and Quebec Sleep Questionnaire) in daytime sleepiness and quality of life. Despite the positive results, more well-designed studies with long-term follow-up are needed to prove the beneficial effects of MARPE as an auxiliary therapy in the treatment of OSA in adults.…”

“…Despite the positive results, more well-designed studies with long-term follow-up are needed to prove the beneficial effects of MARPE as an auxiliary therapy in the treatment of OSA in adults. 85 …”

“…Despite the positive results, more well-designed studies with long-term follow-up are needed to prove the beneficial effects of MARPE as an auxiliary therapy in the treatment of OSA in adults. 85 Minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) was recently proposed by Haas Jr et al 86 The technique consists of outpatient surgery with an incision in the buccal sulcus (region of the upper right and left lateral incisors) followed by four osteotomies: a subspinal osteotomy, a vertical midline osteotomy, and two horizontal lateral osteotomies (one on each side), without separation from the pterygoid pillar. The advantage of this procedure is that it is effective for the correction of maxillary hypoplasia in adult patients, by an outpatient procedure, without the need for hospitalization or general anesthesia.…”

Near-Infrared Light-Controlled MicroRNA-21-Loaded Upconversion Nanoparticles to Promote Bone Formation in the Midpalatal Suture

“…Maxillary transverse deficiency (MTD) is a common skeletal dysplasia of the maxilla . It might lead to occlusal disharmony and functional problems, e.g., breathing disorder. − To correct MTD in adolescents, rapid maxillary expansion (RME) is an effective procedure that mechanically opens the incompletely ossified midpalatal suture . However, relapses after RME have been extensively reported due to its inherent tendency of shape recovery and insufficient bone regenerative capability. − To reduce relapses, numerous studies have investigated the systemic application of chemotherapies (e.g., growth factors − and drugs , ) in promoting bone remodeling after RME.…”