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


CONCLUSIONS
Starting an orthodontic treatment as early as symptoms appear is important in order to increase the efficacy of treatment. An integrated therapy is needed.
Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy. Electronic address: mariapia.villa@uniroma1.it.
Maria Pia
MP
Villa
Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Alessandra
A
Rizzoli
Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Jole
J
Rabasco
Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Ottavio
O
Vitelli
Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Nicoletta
N
Pietropaoli
Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Manuela
M
Cecili
Orthodontic Clinic Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Alessandra
A
Marino
Orthodontic Clinic Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Caterina
C
Malagola
D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010155:Palatal Expansion Technique; D017286:Polysomnography; D011446:Prospective Studies; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
Orthodontic treatment; Pediatric OSA; Rapid maxillary expansion; Residual OSA