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Sleep and Breathing

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28.06.2021 | Sleep Breathing Physiology and Disorders • Original Article

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

verfasst von: Jung-Eun Kim, Kyoung-Jin Hwang, Sung-Wan Kim, Stanley Yung-Chuan Liu, Su-Jung Kim

Erschienen in: Sleep and Breathing | Ausgabe 2/2022

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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.

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.2012-1672CrossRefPubMed

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.2015.10.009CrossRefPubMed

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.2016.10.002CrossRefPubMed

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/21.8.831CrossRefPubMed

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.2019.04.009CrossRefPubMed

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.12378CrossRefPubMed

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.2013.08.015CrossRefPubMed

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.2014.11.019CrossRefPubMed

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.26352CrossRefPubMed

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/s11325-011-0505-1CrossRefPubMed

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.2015.04.012CrossRefPubMed

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/10.1080/08869634.2020.1839722CrossRef

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.2013.03.016CrossRefPubMed

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/10.2319/072014-504.1CrossRefPubMedPubMedCentral

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/10.2319/062520-586.1CrossRefPubMed

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/10.2319/080919-522.1CrossRefPubMedPubMedCentral

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.2021.01.004CrossRefPubMed

18.

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

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.2017.47.3.167CrossRefPubMedPubMedCentral

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/s40510-017-0188-7CrossRef

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)00629-6CrossRefPubMed

22.

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

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.1928CrossRefPubMedPubMedCentral

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.2018.11.023CrossRefPubMed

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.4652CrossRefPubMedPubMedCentral

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.2013.10.011CrossRefPubMed

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/cjw048CrossRefPubMed

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/10.1155/2017/5460429CrossRefPubMedPubMedCentral

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.2020.02.007CrossRefPubMed

Titel: Correlation between craniofacial changes and respiratory improvement after nasomaxillary skeletal expansion in pediatric obstructive sleep apnea patients
verfasst von: Jung-Eun Kim
Kyoung-Jin Hwang
Sung-Wan Kim
Stanley Yung-Chuan Liu
Su-Jung Kim
Publikationsdatum: 28.06.2021
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 2/2022
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02426-9

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