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Maxillary Expansion Treatment of Obstructive Sleep Apnea in Children - Pilot Study
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A2006 - Maxillary Expansion Treatment of Obstructive Sleep Apnea in Children - Pilot Study
Author Block: B. T. Pliska1, J. Pauwels2, N. K. Chadha2; 1Oral Health Sciences, University of British Columbia, Vancouver, BC, Canada, 2Division of Pediatric Otolaryngology, British Columbia Children's Hospital, Vancouver, BC, Canada.
RATIONALE
Obstructive sleep apnea (OSA) is common with potentially dire consequences for quality of life, neurocognitive development and cardio-respiratory health in children. The current first line of treatment—adenotonsillectomy (AT)—carries inherent significant surgical risk, and many children will see incomplete resolution of their symptoms after surgery. The orthodontic office-based treatment of maxillary expansion (ME), which corrects the skeletal and dental constriction often observed in this population, has significant potential as a less invasive, more cost-effective and safer treatment for pediatric OSA. Despite this potential promise, ME for pediatric OSA has not been adequately assessed and validated as a treatment option in a clinical setting.
METHODS
For this pilot prospective observational trial examining ME as an alternative to AT, subjects aged 5-9 years, and referred to the Pediatric Otolaryngology clinic at BC Children’s Hospital for evaluation of sleep disordered breathing, were recruited. During their initial visit, all patients underwent a baseline interview and comprehensive clinical examination by both a Pediatric Otolaryngologist and Orthodontist and if indicated, were referred for full polysomnography. Eligibility criteria included presence of maxillary constriction and posterior dental crossbite, objectively diagnosed OSA (AHI>2) and hypertrophic adenoids and tonsils. Recruited patients were treated with orthodontic maxillary expansion and 5 months later were reassessed both clinically and through a repeat polysomnography. Outcome data included change in OSA-18 questionnaire scores and AHI pre- and post-maxillary expansion treatment; data were analyzed with non-parametric Wilcoxon signed-rank tests.
RESULTS
A total of 236 patients were screened and 13 (mean age=7.5±1.3, 10 females) met all inclusion criteria and underwent ME. The mean baseline AHI was 7.1±5.7 and initial OSA-18 score 62.5±18.8. Five months following expansion treatment, the majority of children saw objective and subjective improvement in their OSA, though overall mean changes in AHI (1.2, 95%CI [-2.1, 4.6] and OSA-18 score (-8.5, 95%CI [-19.7,2.6] were not statistically significant.
CONCLUSIONS
Preliminary data have demonstrated proof of concept for the effectiveness of maxillary expansion as potential treatment for OSA in children with adenotonsillar hypertrophy and maxillary constriction. Further research is warranted to determine the characteristics of children with OSA most likely to benefit from maxillary expansion.
Author Block: B. T. Pliska1, J. Pauwels2, N. K. Chadha2; 1Oral Health Sciences, University of British Columbia, Vancouver, BC, Canada, 2Division of Pediatric Otolaryngology, British Columbia Children's Hospital, Vancouver, BC, Canada.
RATIONALE
Obstructive sleep apnea (OSA) is common with potentially dire consequences for quality of life, neurocognitive development and cardio-respiratory health in children. The current first line of treatment—adenotonsillectomy (AT)—carries inherent significant surgical risk, and many children will see incomplete resolution of their symptoms after surgery. The orthodontic office-based treatment of maxillary expansion (ME), which corrects the skeletal and dental constriction often observed in this population, has significant potential as a less invasive, more cost-effective and safer treatment for pediatric OSA. Despite this potential promise, ME for pediatric OSA has not been adequately assessed and validated as a treatment option in a clinical setting.
METHODS
For this pilot prospective observational trial examining ME as an alternative to AT, subjects aged 5-9 years, and referred to the Pediatric Otolaryngology clinic at BC Children’s Hospital for evaluation of sleep disordered breathing, were recruited. During their initial visit, all patients underwent a baseline interview and comprehensive clinical examination by both a Pediatric Otolaryngologist and Orthodontist and if indicated, were referred for full polysomnography. Eligibility criteria included presence of maxillary constriction and posterior dental crossbite, objectively diagnosed OSA (AHI>2) and hypertrophic adenoids and tonsils. Recruited patients were treated with orthodontic maxillary expansion and 5 months later were reassessed both clinically and through a repeat polysomnography. Outcome data included change in OSA-18 questionnaire scores and AHI pre- and post-maxillary expansion treatment; data were analyzed with non-parametric Wilcoxon signed-rank tests.
RESULTS
A total of 236 patients were screened and 13 (mean age=7.5±1.3, 10 females) met all inclusion criteria and underwent ME. The mean baseline AHI was 7.1±5.7 and initial OSA-18 score 62.5±18.8. Five months following expansion treatment, the majority of children saw objective and subjective improvement in their OSA, though overall mean changes in AHI (1.2, 95%CI [-2.1, 4.6] and OSA-18 score (-8.5, 95%CI [-19.7,2.6] were not statistically significant.
CONCLUSIONS
Preliminary data have demonstrated proof of concept for the effectiveness of maxillary expansion as potential treatment for OSA in children with adenotonsillar hypertrophy and maxillary constriction. Further research is warranted to determine the characteristics of children with OSA most likely to benefit from maxillary expansion.
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