The effect of adenotonsillectomy and rapid maxillary expansion on the upper airway in pediatric obstructive sleep apnea: a randomized crossover-controlled trial

Maria Cecilia Magalhães; Carlos José Soares; Eustáquio A Araújo; Gabriela de Rezende Barbosa; Ricardo Maurício O Novaes; Vinicius Vasconcelos Teodoro; David Normando; Ki Beom Kim; Guilherme A Almeida

doi:10.1093/sleep/zsab304

The effect of adenotonsillectomy and rapid maxillary expansion on the upper airway in pediatric obstructive sleep apnea: a randomized crossover-controlled trial

Sleep. 2021 Dec 31:zsab304. doi: 10.1093/sleep/zsab304. Online ahead of print.

Authors

Maria Cecilia Magalhães¹, Carlos José Soares², Eustáquio A Araújo³, Gabriela de Rezende Barbosa⁴, Ricardo Maurício O Novaes⁵, Vinicius Vasconcelos Teodoro⁶, David Normando⁷, Ki Beom Kim⁸, Guilherme A Almeida⁹

Affiliations

¹ Post-Graduate Student, Department of Pediatric Dentistry and Orthodontics, Federal University of Uberlândia, Uberlândia, Brazil.
² Professor and Chairman, Department of Dental Materials, School of Dentistry, Federal University of Uberlândia Uberlândia, Brazil.
³ Professor, Department of Orthodontics, Center for Advanced Dental School (CADE), Saint Louis University, Saint Louis, Mo.
⁴ Professor, Departament of Stomatological Diagnosis, Federal University of Uberlândia, Uberlândia, Brazil.
⁵ Professor, Department of Otorhinolaryngology, Federal University of Uberlandia, Uberlandia, Brazil.
⁶ Professor, Department of Neurology, Federal University of Uberlandia, Uberlandia, Brazil.
⁷ Professor, Department of Orthodontics, Federal University of Para, Belem, Brazil.
⁸ Professor and Chairman, Department of Orthodontics, Center for Advanced Dental School (CADE), Saint Louis University, Saint Louis, Mo.
⁹ Professor, Departament of Pediatric Dentistry and Orthodontics, Federal University of Uberlândia, Uberlândia, Brazil.

PMID: 34971398
DOI: 10.1093/sleep/zsab304

Abstract

Study objectives: We aimed to determine the effects of adenotonsillectomy (AT) and rapid maxillary expansion (RME) on the apnea-hypopnea index (AHI) and compare volumetric changes in the upper airway (UA) arising from AT and RME.

Methods: Thirty-nine children who presented with maxillary constriction and grade III/IV tonsillar hypertrophy were randomized into two groups. One group underwent AT as the first treatment, and the other group underwent RME. Polysomnography (PSG) and cone-beam computed tomography (CBCT) were conducted before (T0) and 6 months after the first treatment (T1). In a crossover design, individuals with AHI>1 received the second treatment. Six months later, they underwent PSG and CBCT (T2). The influence of age, sex, tonsil and adenoid hypertrophy, initial AHI severity, initial volume of the UA, first treatment, and maxillary expansion amount was evaluated using linear regression analysis. Intra- and inter-group comparisons for AHI and inter-group comparisons of volumetric changes in each region of the UA were performed using a paired t-test and Wilcoxon test.

Results: The initial AHI severity and therapeutic sequence in which AT was the first treatment explained for 95.6% of AHI improvement. AT caused significant improvements in the AHI and volumetric increases in the buccopharynx and total UA areas compared to RME.

Conclusions: The initial AHI severity and AT as the first treatment accounted for most of the AHI improvement. Most reductions in AHI were due to AT, which promoted more volumetric increases in UA areas than RME. RME may have a marginal effect on pediatric obstructive sleep apnea.

Keywords: Maxillary Expansion; Obstructive; Sleep apnea; Tonsillectomy.

Publication types

Retracted Publication