Title Transverse Palatal Expansion with Mini-implant Assisted Rapid Palatal Expander (MARPE) Appliance on Non-obese Adult Patients with Severe Obstructive Sleep Apnea (OSA) Improves Symptoms of OSA
Clinical Question For a non-obese adult patient with obstructive sleep apnea, to what extent does transverse maxillary skeletal expansion with a MARPE help resolve OSA symptoms compared to a non-obese adult with OSA who were not treated with the MARPE appliance?
Clinical Bottom Line For non-obese adult patients with symptoms of obstructive sleep apnea, successful transverse maxillary skeletal expansion with a MARPE can improve symptoms of OSA.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
35102477Brunetto/202224 adult patients with OSA severity of an Apnea/Hypopnea index (AHI) of 5<Prospective Cohort Study
Key resultsThe intervention group that was treated with the MARPE appliance for transverse skeletal expansion showed statistically significant improvements (p<0.05) “on the following parameters: apnea/hypopnea index (65.3%), mean oxygen saturation, snoring duration, and bruxism to apnea index. Approximately one-third of the intervention participants finished the trial with an AHI<5.” Minimal bias was detected in study design. One of the authors had a patent on the specific expander that was utilized. However, the study design was sound. Patients were selected from a variety of universities/private practices based on an objective inclusion/exclusion criteria. Surveys utilized are standard surveys used to detect sleep apnea in medicine.
29090123Hur/20171 adult patient (18yom) with a narrow transverse palateCase report
Key resultsMARPE transverse skeletal expansion in a non-obese individual showed increased airflow through the nasal airway using a 3D volumetric fluid analysis on a non-obese 18-year-old male patient with OSA. Because n=1, researchers may have been biased to publish a successful case to justify the intervention without reporting any failed cases.
Evidence Search (MARPE OR mini-implant assisted rapid palatal expansion OR miniscrew assisted rapid palatal expansion) AND (obstructive sleep apnea OR OSA)
Comments on
The Evidence
The JBI critical appraisal checklist was used to evaluate the validity of the evidence. The criteria for participation study, both for the control and intervention groups, were clearly outlined. Individuals with a defined level of OSA and transverse maxillary skeletal deficiency who were free from other medical co-morbidities that contribute to OSA were included in the study. Participants that met the criteria of the study were recruited from a population of patients being treated at the dental centers cited in the study. The intervention was applied and measured in a valid and reliable way, using a medical history and physical evaluation, Hepworth sleepiness scale, Quebec sleep questionnaire, home sleep test and CBCT. The degree of severity of OSA was graded using the AHI (Apnea-Hypopnea Index) tool. Mean values from the participants in each group were compared and the significance level of 0.05 and study power of 80% was set. Confounding factors of weight change, BMI, and neck circumference (airway) were identified and accounted for throughout the study to ensure integrity of results. The follow up time after the intervention was standard, which is 6 months after expansion is achieved with the MARPE. The measurements of the intervention group were compared pre and post intervention and compared with the measurements from the control group. This is an ongoing study with continual follow up on the subjects.
Applicability Healthy adult patients (18+) with maxillary skeletal transverse deficiency who suffer from obstructive sleep apnea and have successful maxillary expansion with a MARPE appliance can see improved OSA symptoms as measured by the HST, ESS and QSQ. Healthy adult patients can be defined as those who are non-obese (BMI <35) and are free of medical co-morbidities that affect sleep (pulmonary disease, neurological disorders, heart failure), concurrent sleep disorders (central apnea, parasomnias, narcolepsy, insomnia, et), systemic diseases, severe craniofacial anomalies, pharyngeal pathology, or previous orthodontic treatment.
Specialty (Orthodontics) (Interprofessional CATs)
Keywords MARPE, Mini-implant assisted rapid palatal expander, obstructive sleep apnea, OSA, nasal cavity, rapid palatal expander, transverse deficiency
ID# 3540
Date of submission 10/19/2023
E-mail james.r.otani@gmail.com
Author James Otani, DDS
Co-author(s) Jesus Ojeda, DDS
Co-author(s) e-mail ojedaj1@livemail.uthscsa.edu
Faculty mentor Maria Karakousoglou
Faculty mentor e-mail karakousoglo@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
None available