Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review

Barbosa, Denise Fernandes; Bana, Laura Fernandes; Michel, Maria Cristina Buta; Cruz, Miguel Meira e; Zancanella, Edilson; Júnior, Almiro José Machado

doi:10.1016/j.bjorl.2023.02.004

Cited by 8 publications

(3 citation statements)

References 41 publications

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“…Study outcomes included changes in AHI, minimum O2 saturation, or posterior airway space. 28,56,58,59,[72][73][74][75] Study limitations included either very short or no follow-up assessments to judge the stability of changes or evaluation of parameters such as posterior airway space that do not correlate with improvement in AHI. 62,76 It must also be recognized that research participants enrolled in the studies were undergoing RME to correct a maxillary transverse deficiency, and no data were found that examined RME in OSA patients without a transverse deficiency.…”

Section: Pediatric Osamentioning

confidence: 99%

Novel Therapies for Preventing, Managing and Treating Obstructive Sleep Apnea and Snoring in Pediatric and Adult Patients

Sheats,

Masse,

Levine

et al. 2024

J Dent Sleep Med

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Section: Pediatric Osamentioning

confidence: 99%

Novel Therapies for Preventing, Managing and Treating Obstructive Sleep Apnea and Snoring in Pediatric and Adult Patients

Sheats,

Masse,

Levine

et al. 2024

J Dent Sleep Med

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“…Research conducted on pediatric patients with OSA has indicated that watchful waiting has an equivalent effect on any change in the apnea–hypopnea index (AHI) as palatal expansion [ 5 ]. It appears that studies utilizing polysomnography to assess AHI in pediatric patients do not endorse the use of palatal expansion for the treatment or prevention of OSA [ 27 ]. Instead, the use of palatal expanders is advocated solely for orthodontic clinical purposes [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

“…It appears that studies utilizing polysomnography to assess AHI in pediatric patients do not endorse the use of palatal expansion for the treatment or prevention of OSA [ 27 ]. Instead, the use of palatal expanders is advocated solely for orthodontic clinical purposes [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnea: What is an orthodontist’s role?

Kazmierski

2024

Prog Orthod.

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Background The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper’s release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. Results Part of an orthodontist’s role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. Conclusions Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient.

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Impact of adenotonsillectomy and palatal expansion on the apnea‐hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross‐over randomized controlled trial

Magalhães,

Normando,

Soares

et al. 2024

Pediatric Pulmonology

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ObjectiveTo determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea‐hypopnea index (AHI) and minimum oxygen saturation (MinSaO2) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship.Study Design/MethodsThirty‐two nonobese children with balanced maxillomandibular relationship and a mean age of 8.8 years, with a graded III/IV tonsillar hypertrophy and maxillary constriction, participated in a cross‐over randomized controlled trial. As the first intervention, one group underwent AT while the other underwent RPE. After 6 months, interventions were switched in those groups, but only to participants with an AHI > 1 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T0), 6 months after the first (T1) and the second (T2) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO2 severity, and intervention sequence were evaluated using linear regression analysis. Intra‐ and intergroup comparisons for AHI and MinSaO2 were performed using ANOVA and Tukey's test.ResultsThe initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO2 severity accounted for 83.1% of MinSaO2 improvement changes. Most AHI reductions and MinSaO2 improvements were due to AT.ConclusionsInitial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO2 severity alone accounted for the most changes in MinSaO2 increase. In most cases, RPE had a marginal effect on AHI and MinSaO2 when adjusted for confounders.

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Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review

Cited by 8 publications

References 41 publications

Novel Therapies for Preventing, Managing and Treating Obstructive Sleep Apnea and Snoring in Pediatric and Adult Patients

Novel Therapies for Preventing, Managing and Treating Obstructive Sleep Apnea and Snoring in Pediatric and Adult Patients

Obstructive sleep apnea: What is an orthodontist’s role?

Impact of adenotonsillectomy and palatal expansion on the apnea‐hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross‐over randomized controlled trial

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