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Correlation between craniofacial changes and respiratory improvement after nasomaxillary skeletal expansion in pediatric obstructive sleep apnea patients

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

The aim of this study was to investigate the correlation between the changes in respiratory function and dimensions of the nasomaxillary complex (NMC) and upper airway (UA) compartments after nasomaxillary skeletal expansion (NMSE) treatment for pediatric patients with obstructive sleep apnea (OSA).

Methods

Nonobese OSA patients (mean age, 13.6 ± 2.9 years; mean body mass index, 18.1 ± 3.0 kg/m2); mean apnea–hypopnea index (AHI, 7.0 ± 5.4 events/h) presenting with transverse nasomaxillary constriction were evaluated before and after NMSE using cone-beam computed tomography (CBCT), home sleep test, and modified pediatric sleep questionnaire (m-PSQ). Paired t tests were performed to examine the treatment-related changes in all the parameters, and a multiple regression analysis adjusted for age and sagittal and vertical skeletal patterns was conducted to determine the dimensional parameters to affect the functional improvement.

Results

Among 26 patients, NMSE treatment significantly increased NMC dimensions at all tested levels and all UA compartments in CBCT, except glossopharyngeal airway. Concurrently, AHI, oxygen desaturation index, the lowest oxygen saturation (LSaO2), flow limitation (FL), snoring, and m-PSQ were significantly improved. AHI reduction was correlated with UA enlargement with no correlation with NMC expansion, whereas FL reduction was affected by NMC expansion. The minimal cross-sectional area was the most predictive of functional improvement, presenting correlations with AHI, LSaO2, and m-PSQ.

Conclusion

NMSE can be a good treatment for pediatric OSA patients when applied to enhance the nasal and pharyngeal airway patencies beyond the NMC, ultimately to improve pharyngeal collapsibility as well as nasal airflow.

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References

  1. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):e714–e755. https://doi.org/10.1542/peds.2012-1672

    Article  PubMed  Google Scholar 

  2. DelRosso LM (2016) Epidemiology and diagnosis of pediatric obstructive sleep apnea. Curr Probl Pediatr Adolesc Health Care 46(1):2–6. https://doi.org/10.1016/j.cppeds.2015.10.009

    Article  PubMed  Google Scholar 

  3. Zinchuk AV, Gentry MJ, Concato J, Yaggi HK (2017) Phenotypes in obstructive sleep apnea: a definition, examples and evolution of approaches. Sleep Med Rev 35:113–123. https://doi.org/10.1016/j.smrv.2016.10.002

    Article  PubMed  Google Scholar 

  4. Cistulli PA, Palmisano RG, Poole MD (1998) Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep 21(8):831–835. https://doi.org/10.1093/sleep/21.8.831

    Article  CAS  PubMed  Google Scholar 

  5. Behrents RG, Shelgikar AV, Conley RS, Flores-Mir C, Hans M, Levine M, McNamara JA, Palomo JM, Pliska B, Stockstill JW, Wise J, Murphy S, Nagel NJ, Hittner J (2019) Obstructive sleep apnea and orthodontics: an American Association of Orthodontists white paper. Am J Orthod Dentofacial Orthop 156(1):13–28. https://doi.org/10.1016/j.ajodo.2019.04.009

    Article  PubMed  Google Scholar 

  6. Niu X, Di Carlo G, Cornelis MA, Cattaneo PM (2020) Three-dimensional analyses of short-and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: a systematic review and meta-analysis. Orthod Craniofac Res 23(3):250–276. https://doi.org/10.1111/ocr.12378

    Article  PubMed  Google Scholar 

  7. Katyal V, Pamula Y, Daynes CN, Martin J, Dreyer CW, Kennedy D, Sampson WJ (2013) Craniofacial and pper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion. Am J Orthod Dentofacial Orthop 144(6):860–871. https://doi.org/10.1016/j.ajodo.2013.08.015

    Article  PubMed  Google Scholar 

  8. Villa MP, Rizzoli A, Rabasco J, Vitelli O, Pietropaoli N, Cecili M, Marino A, Malagola C (2015) Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children. Sleep Med 16(6):709–716. https://doi.org/10.1016/j.sleep.2014.11.019

    Article  PubMed  Google Scholar 

  9. Camacho M, Chang ET, Song SA, Abdullatif J, Zaghi S, Pirelli P, Certal V, Guilleminault C (2017) Rapid maxillary expansion for pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 127(7):1712–1719. https://doi.org/10.1002/lary.26352

    Article  CAS  PubMed  Google Scholar 

  10. Villa MP, Rizzoli A, Miano S, Malagola C (2011) Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath 15(2):179–184. https://doi.org/10.1007/s11325-011-0505-1

    Article  PubMed  Google Scholar 

  11. Pirelli P, Saponara M, Guilleminault C (2015) Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up. Sleep Med 16(8):933–935. https://doi.org/10.1016/j.sleep.2015.04.012

    Article  PubMed  Google Scholar 

  12. Kim SJ, Ahn HW, Kim SW (2020) Advanced interdisciplinary treatment protocol for pediatric obstructive sleep apnea including medical, surgical, and orthodontic care: a narrative review. Cranio 23:1–13. https://doi.org/10.1080/08869634.2020.1839722

    Article  Google Scholar 

  13. Kheirandish-Gozal L, Gozal D (2013) Genotype–phenotype interactions in pediatric obstructive sleep apnea. Respir Physiol Neurobiol 189(2):338–343. https://doi.org/10.1016/j.resp.2013.03.016

    Article  PubMed  Google Scholar 

  14. Fastuca R, Perinetti G, Zecca PA, Nucera R, Caprioglio A (2015) Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: a longitudinal correlation study. Angle Orthod 85(6):955–961. https://doi.org/10.2319/072014-504.1

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mehta S, Wang D, Kuo CL, Mu J, Vich ML, Allareddy V, Tadinada A, Yadav S (2021) Long-term effects of mini-screw–assisted rapid palatal expansion on airway: a three-dimensional cone-beam computed tomography study. Angle Orthod 91(2):195–205. https://doi.org/10.2319/062520-586.1

    Article  PubMed  Google Scholar 

  16. Li Q, Tang H, Liu X, Luo Q, Jiang Z, Martin D, Guo J (2020) Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion. Angle Orthod 90(3):432–441. https://doi.org/10.2319/080919-522.1

    Article  PubMed  PubMed Central  Google Scholar 

  17. Abu Arqub S, Mehta S, Iverson MG, Yadav S, Upadhyay M, Almuzian M (2021) Does Mini Screw Assisted Rapid Palatal Expansion (MARPE) have an influence on airway and breathing in middle-aged children and adolescents? A systematic review Int Orthod 19(1):37–50. https://doi.org/10.1016/j.ortho.2021.01.004

    Article  PubMed  Google Scholar 

  18. Guilleminault C, Pelayo R (1998) Sleep-disordered breathing in children. Ann Med 30(4):350–356. https://doi.org/10.3109/07853899809029934

    Article  CAS  PubMed  Google Scholar 

  19. Koo YJ, Choi SH, Keum BT, Yu HS, Hwang CJ, Melsen B, Lee KJ (2017) Maxillomandibular arch width differences at estimated centers of resistance: comparison between normal occlusion and skeletal Class III malocclusion. Korean J Orthod 47(3):167. https://doi.org/10.4041/kjod.2017.47.3.167

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cantarella D, Dominguez-Mompell R, Mallya SM, Moschik C, Pan HC, Miller J, Moon W (2017) Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging. Prog Orthod 18(1):1–12. https://doi.org/10.1186/s40510-017-0188-7

    Article  Google Scholar 

  21. Li HY, Chen NH, Wang CR, Shu YH, Wang PC (2003) Use of 3-dimensional computed tomography scan to evaluate upper airway patency for patients undergoing sleep-disordered breathing surgery. Otolaryngol Head Neck Surg 129(4):336–342. https://doi.org/10.1016/s0194-5998(03)00629-6

    Article  PubMed  Google Scholar 

  22. Cho JH, Kim HJ (2017) Validation of ApneaLinkTM Plus for the diagnosis of sleep apnea. Sleep Breath 21(3):799–807. https://doi.org/10.1007/s11325-017-1532-3

    Article  PubMed  Google Scholar 

  23. Grigg-Damberger MM (2012) The AASM Scoring Manual four years later. J Clin Sleep Med 8(3):323–332. https://doi.org/10.5664/jcsm.1928

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pirelli P, Fanucci E, Giancotti A, Di Girolamo M, Guilleminault C (2019) Skeletal changes after rapid maxillary expansion in children with obstructive sleep apnea evaluated by low-dose multi-slice computed tomography. Sleep Med 60:75–80. https://doi.org/10.1016/j.sleep.2018.11.023

    Article  PubMed  Google Scholar 

  25. Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA (2015) Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep 38(5):669–675. https://doi.org/10.5665/sleep.4652

    Article  PubMed  PubMed Central  Google Scholar 

  26. Caprioglio A, Meneghel M, Fastuca R, Zecca PA, Nucera R, Nosetti L (2014) Rapid maxillary expansion in growing patients: correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol 78(1):23–27. https://doi.org/10.1016/j.ijporl.2013.10.011

    Article  PubMed  Google Scholar 

  27. Buck LM, Dalci O, Darendeliler MA, Papageorgiou SN, Papadopoulou AK (2017) Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis. Eur J Orthod 39(5):463–473. https://doi.org/10.1093/ejo/cjw048

    Article  PubMed  Google Scholar 

  28. Di Carlo G, Saccucci M, Ierardo G, Luzzi V, Occasi F, Zicari AM, Duse M, Polimeni A (2017) Rapid maxillary expansion and upper airway morphology: a systematic review on the role of cone beam computed tomography. Biomed Res Int. https://doi.org/10.1155/2017/5460429

    Article  PubMed  PubMed Central  Google Scholar 

  29. Vinha PP, Thuler ER, de Mello-Filho FV (2020) Effects of surgically assisted rapid maxillary expansion on the modification of the pharynx and hard palate and on obstructive sleep apnea, and their correlations. J Craniomaxillofac Surg 48(4):339–348. https://doi.org/10.1016/j.jcms.2020.02.007

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea

    Jung-Eun Kim

  2. Department of Neurology, School of Medicine, Kyung Hee University, Seoul, South Korea

    Kyoung-Jin Hwang

  3. Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, South Korea

    Sung-Wan Kim

  4. Department of Otolaryngology, and of Plastic and Reconstructive Surgery, School of Medicine, Stanford University, Stanford, CA, USA

    Stanley Yung-Chuan Liu

  5. Department of Orthodontics, Kyung Hee University School of Dentistry, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea

    Su-Jung Kim

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  1. Jung-Eun Kim
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  4. Stanley Yung-Chuan Liu
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Correspondence to Su-Jung Kim.

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Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board of Kyung Hee University Dental Hospital (KH-DT20005) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This was a retrospective study based on records; formal consent was not required.

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The authors declare no competing interests.

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Kim, JE., Hwang, KJ., Kim, SW. et al. Correlation between craniofacial changes and respiratory improvement after nasomaxillary skeletal expansion in pediatric obstructive sleep apnea patients. Sleep Breath 26, 585–594 (2022). https://doi.org/10.1007/s11325-021-02426-9

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  • DOI: https://doi.org/10.1007/s11325-021-02426-9

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