J Korean Acad Pediatr Dent.  2019 Nov;46(4):369-381. 10.5933/JKAPD.2019.46.4.369.

Diagnosis and Effect of Maxillary Expansion in Pediatric Sleep-Disordered Breathing

Affiliations
  • 1Byeolgalam Dental Clinic, Korea.
  • 2Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Chonbuk National University, Korea. pedo1997@jbnu.ac.kr

Abstract

The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023). In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.

Keyword

Sleep-disordered breathing; Rapid maxillary expansion; Upper airway width; Pediatric sleep questionnaire; Portable sleep monitoring

MeSH Terms

Cephalometry
Child
Diagnosis*
Early Diagnosis
Humans
Hyoid Bone
Maxilla
Oxygen
Palatal Expansion Technique*
Polysomnography
Respiration
Sleep Apnea Syndromes*
Sleep Wake Disorders
Snoring
Oxygen
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