Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children

Sleep Med. 2015 Jun;16(6):709-16. doi: 10.1016/j.sleep.2014.11.019. Epub 2015 Mar 16.


Objectives: The objectives of this study were to confirm the efficacy of rapid maxillary expansion in children with moderate adenotonsillar hypertrophy in a larger sample and to evaluate retrospectively its long-term benefits in a group of children who underwent orthodontic treatment 10 years ago.

Methods: After general clinical examination and overnight polysomnography, all eligible children underwent cephalometric evaluation and started 12 months of therapy with rapid maxillary expansion. A new polysomnography was performed at the end of treatment (T1). Fourteen children underwent clinical evaluation and Brouilette questionnaire, 10 years after the end of treatment (T2).

Results: Forty patients were eligible for recruitment. At T1, 34/40 (85%) patients showed a decrease of apnea-hypopnea index (AHI) greater than 20% (ΔAHI 67.45% ± 25.73%) and were defined responders. Only 6/40 (15%) showed a decrease <20% of AHI at T1 and were defined as non-responders (ΔAHI -53.47% ± 61.57%). Moreover, 57.5% of patients presented residual OSA (AHI > 1 ev/h) after treatment. Disease duration was significantly lower (2.5 ± 1.4 years vs 4.8 ± 1.9 years, p <0.005) and age at disease onset was higher in responder patients compared to non-responders (3.8 ± 1.5 years vs 2.3 ± 1.9 years, p <0.05). Cephalometric variables showed an increase of cranial base angle in non-responder patients (p <0.05). Fourteen children (mean age 17.0 ± 1.9 years) who ended orthodontic treatment 10 years previously showed improvement of Brouilette score.

Conclusion: Starting an orthodontic treatment as early as symptoms appear is important in order to increase the efficacy of treatment. An integrated therapy is needed.

Keywords: Orthodontic treatment; Pediatric OSA; Rapid maxillary expansion; Residual OSA.

Publication types

  • Clinical Study

MeSH terms

  • Cephalometry
  • Child
  • Child, Preschool
  • Cooperative Behavior
  • Early Medical Intervention
  • Female
  • Humans
  • Interdisciplinary Communication
  • Male
  • Palatal Expansion Technique*
  • Polysomnography
  • Prospective Studies
  • Retrospective Studies
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / etiology
  • Sleep Apnea, Obstructive / therapy*
  • Treatment Outcome