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Effects of surgically assisted rapid maxillary expansion on obstructive sleep apnea and daytime sleepiness

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Abstract

Purpose

The aim of the study was to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on obstructive sleep events and daytime sleepiness in adults with obstructive sleep apnea syndrome (OSAS).

Methods

Sixteen individuals (7 women/9 men) aged 40.2 ± 10.2 (range, 24.4 to 62.2 years) with maxillary transverse deficiency and OSAS (respiratory disturbance index [RDI] greater than 5) confirmed with full-night polysomnography (PSG) underwent SARME to evaluate its efficiency for OSAS treatment.

Results

Several PSG parameters and the Epworth Sleepiness Scale (ESS) results were compared in selected individuals before and after they underwent SARME. An RDI reduction from 35.4 ± 38.5 to 16.0 ± 19.7 was found, corresponding to a mean decrease of 54.6 % (p = 0.0013). A 56.2 % (33.23 ± 39.5 to 14.5 ± 19.4, p = 0.001) decrease was found in the apnea-hypopnea index (AHI), in addition to decreases in the desaturation and microarousal rates, among other parameters. The ESS scores improved from 12.5 ± 5.3 to 7.2 ± 3.5 (p < 0.001).

Conclusions

SARME promotes an improvement in OSAS symptoms; decreases the rates of respiratory disturbances; microarousal, and desaturation; and reduces daytime sleepiness.

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Abbreviations

SARME:

Surgically assisted rapid maxillary expansion

OSAS:

Obstructive sleep apnea syndrome

CIEDEF:

Comprehensive Center for the Study of Defects of the Face (Centro Integrado de Estudo dos Defeitos da Face)

HC-FMRP-USP:

Teaching Hospital of the School of Medicine of Ribeirão Preto, University of São Paulo (Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo)

PSG:

Polysomnography

ESS:

Epworth Sleepiness Scale

RME:

Rapid maxillary expansion

BMI:

Body mass index

TST:

Total sleep time

AHI:

Apnea-hypopnea index

RERAI:

Respiratory effort-related arousals index

RDI:

Respiratory disturbance index

PLM index:

Periodic limb movement index

References

  1. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR (2010) Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 11:441–446. doi:10.1016/j.sleep.2009.10.005

    Article  PubMed  Google Scholar 

  2. Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, Martínez-Alonso M, Carmona C, Barceló A, Chiner E, Masa JF, Gonzalez M, Marín JM, Garcia-Rio F, Diaz de Atauri J, Terán J, Mayos M, de la Peña M, Monasterio C, del Campo F, Montserrat JM, Spanish Sleep and Breathing Network (2012) Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA 307:2161–2168. doi:10.1001/jama.2012.4366

    Article  PubMed  Google Scholar 

  3. Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK (2009) Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med 122:1122–1127. doi:10.1016/j.amjmed.2009.04.026

    Article  PubMed  PubMed Central  Google Scholar 

  4. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235. doi:10.1056/NEJM199304293281704

    Article  CAS  PubMed  Google Scholar 

  5. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31:1071–1078

    PubMed  PubMed Central  Google Scholar 

  6. Cistulli PA (1996) Craniofacial abnormalities in obstructive sleep apnoea: implications for treatment. Respirology 1:167–174. doi:10.1111/j.1440-1843.1996.tb00028.x

    Article  CAS  PubMed  Google Scholar 

  7. Flores-Mir C, Korayem M, Heo G, Witmans M, Major MP, Major PW (2013) Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis. J Am Dent Assoc 144:269–277. doi:10.14219/jada.archive.2013.0113

    Article  PubMed  Google Scholar 

  8. Faria AC, da Silva-Junior SN, Garcia LV, dos Santos AC, Fernandes MR, de Mello-Filho FV (2013) Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA). Sleep Breath 17:395–401. doi:10.1007/s11325-012-0707-1

    Article  PubMed  Google Scholar 

  9. Faria AC, Garcia LV, Santos AC, Diniz PR, Ribeiro HT, Mello-Filho FV (2012) Comparison of the area of the pharynx during wakefulness and induced sleep in patients with obstructive sleep apnea (OSA). Braz J Otorhinolaryngol 78:103–108

    Article  PubMed  Google Scholar 

  10. Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI (2003) Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 168:522–530. doi:10.1164/rccm.200208-866OC

    Article  PubMed  Google Scholar 

  11. Shinohara E, Kihara S, Yamashita S, Yamane M, Nishida M, Arai T, Kotani K, Nakamura T, Takemura K, Matsuzawa Y (1997) Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects. J Intern Med 241:11–18. doi:10.1046/j.1365-2796.1997.63889000.x

    Article  CAS  PubMed  Google Scholar 

  12. Palmisano RG, Wilcox I, Sullivan CE, Cistulli PA (1996) Treatment of snoring and obstructive sleep apnoea by rapid maxillary expansion. Aust N Z J Med 26:428–429

    Article  CAS  PubMed  Google Scholar 

  13. Cistulli PA, Richards GN, Palmisano RG, Unger G, Berthon-Jones M, Sullivan CE (1996) Influence of maxillary constriction on nasal resistance and sleep apnea severity in patients with Marfan’s syndrome. Chest 110:1184–1188. doi:10.1378/chest.110.5.1184

    Article  CAS  PubMed  Google Scholar 

  14. Cistulli PA, Palmisano RG, Poole MD (1998) Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep 21:831–835

    CAS  PubMed  Google Scholar 

  15. Johal A, Conaghan C (2004) Maxillary morphology in obstructive sleep apnea: a cephalometric and model study. Angle Orthod 74:648–656. doi:10.1043/0003-3219(2004)074<0648:MMIOSA>2.0.CO;2

    PubMed  Google Scholar 

  16. Seto BH, Gotsopoulos H, Sims MR, Cistulli PA (2001) Maxillary morphology in obstructive sleep apnoea syndrome. Eur J Orthod 23:703–714. doi:10.1093/ejo/23.6.703

    Article  CAS  PubMed  Google Scholar 

  17. Lee RW, Sutherland K, Chan AS, Zeng B, Grunstein RR, Darendeliler MA, Schwab RJ, Cistulli PA (2010) Relationship between surface facial dimensions and upper airway structures in obstructive sleep apnea. Sleep 33:1249–1254

    PubMed  PubMed Central  Google Scholar 

  18. Kushida CA, Efron B, Guilleminault C (1997) A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med 127:581–587. doi:10.7326/0003-4819-127-8_Part_1-199710150-00001

    Article  CAS  PubMed  Google Scholar 

  19. Zeng B, Ng AT, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2008) Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea. Sleep 31:543–547

    PubMed  PubMed Central  Google Scholar 

  20. Koudstaal MJ, Poort LJ, van der Wal KG, Wolvius EB, Prahl-Andersen B, Schulten AJ (2005) Surgically assisted rapid maxillary expansion (SARME): a review of the literature. Int J Oral Maxillofac Surg 34:709–714. doi:10.1016/j.ijom.2005.04.025

    Article  CAS  PubMed  Google Scholar 

  21. American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  22. Iber C, Ancoli-Israel S, Chesson JRA, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  23. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW (2009) Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 35:877–883. doi:10.1590/S1806-37132009000900009

    Article  PubMed  Google Scholar 

  24. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    CAS  PubMed  Google Scholar 

  25. Seeberger R, Kater W, Davids R, Thiele OC (2010) Long term effects of surgically assisted rapid maxillary expansion without performing osteotomy of the pterygoid plates. J Craniomaxillofac Surg 38:175–178. doi:10.1016/j.jcms.2009.07.003

    Article  PubMed  Google Scholar 

  26. Suri L, Taneja P (2008) Surgically assisted rapid palatal expansion: a literature review. Am J Orthod Dentofac Orthop 133:290–302. doi:10.1016/j.ajodo.2007.01.021

    Article  Google Scholar 

  27. Laudemann K, Petruchin O, Mack MG, Kopp S, Sader R, Landes CA (2009) Evaluation of surgically assisted rapid maxillary expansion with or without pterygomaxillary disjunction based upon preoperative and post-expansion 3D computed tomography data. Oral Maxillofac Surg 13:159–169. doi:10.1007/s10006-009-0167-3

    Article  PubMed  Google Scholar 

  28. Pirelli P, Saponara M, Attanasio G (2005) Obstructive sleep apnoea syndrome (OSAS) and rhino-tubaric disfunction in children: therapeutic effects of RME therapy. Prog Orthod 6:48–61

    PubMed  Google Scholar 

  29. Bach N, Tuomilehto H, Gauthier C, Papadakis A, Remise C, Lavigne F, Lavigne GJ, Huynh N (2013) The effect of surgically assisted rapid maxillary expansion on sleep architecture: an exploratory risk study in healthy young adults. J Oral Rehabil 40:818–825. doi:10.1111/joor.12102

    Article  CAS  PubMed  Google Scholar 

  30. El H, Palomo JM (2014) Three-dimensional evaluation of upper airway following rapid maxillary expansion: a CBCT study. Angle Orthod 84:265–273. doi:10.2319/012313-71.1

    Article  PubMed  Google Scholar 

  31. Kurt G, Altuğ-Ataç AT, Atac MS, Karasu HA (2010) Changes in nasopharyngeal airway following orthopedic and surgically assisted rapid maxillary expansion. J Craniofac Surg 21:312–317. doi:10.1097/SCS.0b013e3181cf5f73

    Article  PubMed  Google Scholar 

  32. Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD (2010) Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 33:1396–1407

    PubMed  PubMed Central  Google Scholar 

  33. Marshall NS, Barnes M, Travier N, Campbell AJ, Pierce RJ, McEvoy RD, Neill AM, Gander PH (2006) Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis. Thorax 61:430–434. doi:10.1136/thx.2005.050583

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kartalian A, Gohl E, Adamian M, Enciso R (2010) Cone-beam computerized tomography evaluation of the maxillary dentoskeletal complex after rapid palatal expansion. Am J Orthod Dentofac Orthop 138:486–492. doi:10.1016/j.ajodo.2008.10.025

    Article  Google Scholar 

  35. Chang Y, Koenig LJ, Pruszynski JE, Bradley TG, Bosio JA, Liu D (2013) Dimensional changes of upper airway after rapid maxillary expansion: a prospective cone-beam computed tomography study. Am J Orthod Dentofac Orthop 143:462–470. doi:10.1016/j.ajodo.2012.11.019

    Article  Google Scholar 

  36. Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kakuno E, Kanomi R, Hayasaki H, Yamasaki Y (2013) Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study. Am J Orthod Dentofac Orthop 143:235–245. doi:10.1016/j.ajodo.2012.09.014

    Article  Google Scholar 

  37. Ozbek MM, Memikoglu UT, Altug-Atac AT, Lowe AA (2009) Stability of maxillary expansion and tongue posture. Angle Orthod 79:214–220. doi:10.2319/010908-12.1

    Article  PubMed  Google Scholar 

  38. Phoenix A, Valiathan M, Nelson S, Strohl KP, Hans M (2011) Changes in hyoid bone position following rapid maxillary expansion in adolescents. Angle Orthod 81:632–638. doi:10.2319/060710-313.1

    Article  PubMed  Google Scholar 

  39. Iwasaki T, Takemoto Y, Inada E, Sato H, Suga H, Saitoh I, Kakuno E, Kanomi R, Yamasaki Y (2014) The effect of rapid maxillary expansion on pharyngeal airway pressure during inspiration evaluated using computational fluid dynamics. Int J Pediatr Otorhinolaryngol 78:1258–1264

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank the São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP]) for their financial support of this study. This study was funded by the government of the State of São Paulo through the São Paulo State Research Foundation (FAPESP).

Ethical standards

Clinical trial registered with the National Health Council/National Ethics and Research Council (Conselho de Nacional de Saúde/Conselho Nacional de Ética em Pesquisa [CONEP]), http://portal2.saude.gov.br/sisnep/menu_principal.cfm, CAAE 0127.0.004.000-10

Conflict of interest

There are no conflicts of interest or funding by the industry or related individuals.

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Authors and Affiliations

  1. School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil, 14049-900

    Pedro Pileggi Vinha, Alan Luiz Eckeli, Ana Célia Faria & Francisco Veríssimo de Mello-Filho

  2. School of Dentistry of Ribeirão Preto, University of São Paulo, School of Dentistry, Campus USP, Ribeirão Preto, São Paulo, 14040-904, Brazil

    Samuel Porfirio Xavier

  3. Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil, 14049-900

    Pedro Pileggi Vinha

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  1. Pedro Pileggi Vinha
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  2. Alan Luiz Eckeli
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Correspondence to Pedro Pileggi Vinha.

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Vinha, P.P., Eckeli, A.L., Faria, A.C. et al. Effects of surgically assisted rapid maxillary expansion on obstructive sleep apnea and daytime sleepiness. Sleep Breath 20, 501–508 (2016). https://doi.org/10.1007/s11325-015-1214-y

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