Title Early orthodontic treatment with Rapid Maxillary Expansion in children with Obstructive Sleep Apnea may become an alternative treatment to surgery
Clinical Question Does RME resolve symptoms of Obstructive Sleep Apnea in children with upper airway obstruction with concomitant malocclusion?
Clinical Bottom Line Young children with OSA benefit from early orthodontic treatment with RME. Orthodontic therapy should be encouraged in OSA as early approach may help stably modify nasal breathing and respiration,thereby preventing obstruction of the upper airway.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
17239661Villa/200714 children between ages of 4 to 11.Open clinical trial
Key resultsThe results can be divided into three sections. 1. Questionnaire responses:The mean clinical score for severity of OSAS improved significantly (13/14)92.8%.Fall of at least 2 points in the score. 2. Polysomnographic Recordings: AHI(apnea-hypopnea index) diminished significantly from baseline(5.8 vs 1.5;p=0.005). OHI(obstructive hyopnea index)improved significantly (3.1 vs 0.9;p=0.002) as did arousal index (17.2 vs 9.2;p=0.001) 3.Oto-rhino-laryngologic examination:In patients with mild tonsillar hypertrophy the mean AHI decreased (5.6 events/h vs 1 events/h;p=0.034) and in patients with severe tonsillar hypertrophy the mean AHI decreased.(6.2events/h vs 2.3 events; p=ns).
21437777Villa/201110 children between ages 4 to 11.Clinical trial- long term follow up.
Key resultsThis study is a follow up of the 12 month therapeutic study at 36 months. Only one subject out of 10 showed moderate tonsillar hypertrophy. All parents reported improvement in some symptoms(snoring and oral breathing) after 24 months of RME application. AHI and SaO2 values did not change significantly.
Evidence Search Rapid[All Fields] AND ("palatal expansion technique"[MeSH Terms] OR ("palatal"[All Fields] AND "expansion"[All Fields] AND "technique"[All Fields]) OR "palatal expansion technique"[All Fields] OR ("maxillary"[All Fields] AND "expansion"[All Fields]) OR "maxillary expansion"[All Fields]) AND ("child"[MeSH Terms] OR "child"[All Fields] OR "children"[All Fields]) AND ("obstructive sleep apnoea"[All Fields] OR "sleep apnea, obstructive"[MeSH Terms] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "obstructive"[All Fields]) OR "obstructive sleep apnea"[All Fields] OR ("obstructive"[All Fields] AND "sleep"[All Fields] AND "apnea"[All Fields]))
Comments on
The Evidence
Both articles represent a continuum of the same study at 12 and 36 months.It was an open clinical trial involving children who received treatment for OSA with RME. It had the unavoidable limitation of having no control group as it would be unethical to keep children from treatment.The strengths of the study are that it is very well designed with multiple parameters of assessment and long term follow-up at 12 and 36 months. The results should be considered with caution given the low level of evidence.
Applicability For Orthodontists and Oto-rhino-laryngologists. It is an alternate to invasive surgical procedures.It is also a relatively simple, painless and effective procedure and therefore may be considered in children with OSA. However, the study and the results have to be considered with caution as it presents a low level of evidence and has to be complemented with more comprehensive future studies.
Specialty (Orthodontics)
Keywords Rapid Maxillary Expansion,Children,Obstructive Sleep Apnea
ID# 2331
Date of submission 10/25/2012
E-mail vishwanath@uthscsa.edu
Author Meenakshi Vishwanath
Co-author(s) e-mail
Faculty mentor Peter T. Gakunga, BDS, MS, PhD
Faculty mentor e-mail gakunga@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
by Ryushiro Sugita, DDS (San Antonio, Texas) on 11/17/2015
A PubMed search on the rapid maxillary expansion in children with OSA was performed Oct 2015. A more recent publication was found: Villa 2015, PubMed: 25934539. This retrospective cohort study including forty participants showed that at the end of treatment 34/40 (85%) patients showed a decrease of apnea-hypopnea index (AHI) greater than 20% (ΔAHI 67.45% ± 25.73%) and were defined as responders. This study showed similar results as those published in this CAT. Starting an orthodontic treatment as early as symptoms appear is important in order to increase the efficacy of treatment. An integrated therapy is needed.