ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Low Level Evidence shows Rapid Maxillary Expansion is Effective in Treating Children with Obstructive Sleep Apnea Syndrome
Clinical Question Is rapid maxillary expansion an effective treatment option for childhood obstructive sleep apnea?
Clinical Bottom Line For pediatric patients with obstructive sleep apnea, rapid maxillary expansion can be effective in reducing AHI and symptoms, however, this is based on only several clinical trials without controls and with small sample size, therefore the level of evidence supporting the use of RME in treating OSA is low.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21437777Villa/201114 pts (6.6±2.0yo) with dental malocclusion, BMI<85%, OSAS confirmed by polysomnographyClinical Trial( no control) /Case Series
Key resultsThis is a follow up report on their 2007 article (PMID)17239661). At the end of 12 month RME treatment, polysomnography showed a significant decrease in the apnea-hypopnea index(p<0.005), hypopnea obstructive index (p=0.002), and arousal index (p=0.001). Post-treatment questionnaire responses showed a significant decrease in the severity of symptoms. 10 out of 14 children were enrolled in the follow up study, 24 months after the end of treatment, no significant changes in the AHI or in other variables were observed in majority of the children treated (8/10).
#2) 20451029Pirelli/201060 pt ( 6-13 yo, average 7.3 yo) with maxillary contraction, no adenoid hypertrophy, BMI <24kg/m2, OSAS confirmed by polysomnographyProspective cohort study
Key resultsData were collected and compared 1) before the orthodontic therapy (pretreatment T0); (2) 1 month (T1) after therapy, with the device still in place; and (3) 4 months after the end of orthodontic treatment, which lasted 6 to 12 months. The average cross-sectional maxillary expansion was 5.91 ± 0.7 mm. An average increase of the pyriform opening was 3.85±0.3mm. At T0, the baseline of AHI ranged from 6.1-22.4/hour (average 16.3± 2.5), at T1, the average of AHI is 8.3 ± 2.3, at T2, the average of AHI is 0.8 ±1.3 (p=.000). "RME therapy widens nasal fossa and releases the septum, thus restoring a normal nasal airflow with disappearance of obstructive sleep-disordered breathing."
#3) 15283012Pirelli/200431 pt (mean 8.7 year) with maxillary contraction, no adenoid hypertrophy, BMI <24kg/m2. OSAS confirmed by polysomnographyProspective cohort study
Key resultsData were collected and compared 1) before the orthodontic therapy (pretreatment T0); (2) 4-6 weeks (T1) after therapy, with the device still in place; and (3) 4 months after the end of orthodontic treatment, which lasted 6 to 12 months. Prior to the RME treatment, the mean AHI was 12.2 events/hour. At T1, 29 out of 31 patient has and AHI<5, the other 2 patient had an AHI of 6.3 and 8.1 per hour, respectively, from an initial AHI of 19.6 and 21.1 (P=0.001). At the 4 month follow-up (T2), the anterior rhinometry was normal, and all children has an AHI<1 event per hour (p=0.0001). The mean cross-sectional expansion of the maxilla was 4.32± 0.7 mm. The mean increase of pyriform opening was 1.3±0.3 mm.
Evidence Search Sleep apnea, obstructive/therapy, Palatal expansion technique, Rapid maxillary expansion
Comments on
The Evidence
There is no randomized controlled clinical trial assessing the efficacy of RME therapy on pediatric OSA. Available evidences supporting the use of RME are bases on several clinical trials without controls. Both Pirelli’s studies only included children without enlarged adenoid. In Villa’s studies, children with different levels of tonsillar hypertrophy are included, however, the sample size in these studies are very small. Therefore, the use of RME in children with adenoid or tonsillar hypertrophy is not clear. Both Pirelli’s studies have no more than 16 month follow-up time, while in Villa’s study, the therapeutic effect of RME can be observed in 8 out of 10 children after 36 month, however, the long-term efficacy of RME cannot be established due to small sample size.
Applicability Rapid maxillary expansion, as a commonly used orthodontic technique, can be considered as a promising alternative treatment of OSAS in children, particular those who have maxillary constriction and without enlarged adenoid. However, current data are insufficient to recommend its use due to low level of evidence.
Specialty/Discipline (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords obstructive sleep apnea, children, rapid maxillary expansion, palatal expansion
ID# 2343
Date of submission: 03/19/2013spacer
E-mail xuz@uthscsa.edu
Author Zheng Xu, DDS
Co-author(s) Manshi Patel
Co-author(s) e-mail patelmh@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
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