Diagnosis and Effect of Maxillary Expansion in Pediatric Sleep-Disordered Breathing (소아 수면호흡장애의 진단과 상악확장술의 치료효과)

Doyoung Kim (김도영); Kyounghee Baek (백경희); LEE DAE-WOO (이대우); KIM JAE GON (김재곤); Yang Yeon Mi (양연미)

doi:10.5933/JKAPD.2019.46.4.369

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

Journal of the Korean academy of pediatric dentistry
Abbr : J Korean Acad Pediatr Dent
2019, 46(4), pp.369-381
DOI : 10.5933/JKAPD.2019.46.4.369
Publisher : The Korean Academy Of Pediatric Dentistry
Research Area : Medicine and Pharmacy > Dentistry
Received : July 23, 2019
Accepted : August 21, 2019
Published : November 27, 2019

Doyoung Kim ¹, Kyounghee Baek ², LEE DAE-WOO ³, KIM JAE GON ³, Yang Yeon Mi ³

¹별가람소아치과
²전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소
³전북대학교

Accredited

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.

KEYWORDS

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

Citation status

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[journal] Marcus CL / 2001 / Sleep-disordered breathing in children / Am J Respir Crit Care Med 164 : 16~30

[journal] Lumeng JC / 2008 / Epidemiology of pediatric obstructive sleep apnea / Proc Am Thorac Soc 5 : 242~252

[journal] 이승훈 / 2013 / Obstructive Sleep Apnea Syndrome in Children / Hanyang Medical Reviews / 한양대학교 의과대학 33(4) : 246~252

[journal] Marcus CL / 2012 / Diagnosis and management of childhood obstructive sleep apnea syndrome / Pediatrics 130 : 714~755

[journal] Berry RB / 2015 / AASM scoring manual version 2.2 updates: new chapters for scoring infant sleep staging and home sleep apnea testing / J Clin Sleep Med 11 : 1253~1254

[journal] Schechter MS / 2002 / Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome / Pediatrics 109 : 69~

[journal] Spruyt K / 2011 / Development of pediatric sleep questionnaires as diagnostic or epidemiological tools : a brief review of dos and don’ts / Sleep Med Rev 15 : 7~17

[journal] Spruyt K / 2011 / Pediatric sleep questionnaires as diagnostic or epidemiological tools : a review of currently available instruments / Sleep Med Rev 15 : 19~32

[journal] Chervin RD / 2000 / Pediatric sleep questionnaire(PSQ) : validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems / Sleep Med 1 : 21~32

[journal] Hamada M / 2012 / Home monitoring using portable polygraphy for perioperative assessment of pediatric obstructive sleep apnea syndrome / Tokai J Exp Clin Med 37 : 66~70

[journal] Villa M / 2011 / Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome : 36 months of follow-up / Sleep Breath 15 : 179~184

[journal] Pirelli P / 2004 / Rapid maxillary expansion in children with obstructive sleep apnea syndrome / Sleep 27 : 761~766

[journal] Pirelli P / 2015 / Rapid maxillary expansion(RME)for pediatric obstructive sleep apnea : a 12-year follow-up / Sleep Med 16 : 933~935

[journal] Fujioka M / 1979 / Radiographic evaluation of adenoidal size in children : adenoidal-nasopharyngeal ratio / AJR Am J Roentgenol 133 : 401~404

[journal] Marcus CL / 2001 / Sleep-disordered breathing in children / Am J Respir Crit Care Med 164 : 16~30

[journal] Jeans WD / 1981 / A longitudinal study of the growth of the nasopharynx and its contents in normal children / Br J Radiol 54 : 117~121

[journal] Brunetti L / 2001 / Prevalence of obstructive sleep apnea syndrome in a cohort of 1, 207 children of southern Italy / Chest 120 : 1930~1935

[journal] Linder-Aronson S / 1970 / Adenoids. Their effect on mode of breathing and nasal air flow and their relationship to characteristics of the facial skeleton and the dentition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids / Acta Otolaryngol Suppl 265 : 1~132

[journal] Johns MW / 1991 / A new method for measuring daytime sleepiness : the epworth sleepiness scale / Sleep 14 : 540~545

[journal] Schechter MS / 2002 / Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome / Pediatrics 109 : 69~

[journal] Tan HL / 2014 / Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea / Sleep 37 : 255~260

[journal] Kaditis AG / 2016 / Obstructive sleep disordered breathing in 2 to 18 year old / Eur Respir J 47 : 69~94

[journal] Alonso-Álvarez ML / 2015 / Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children / Chest 147 : 1020~1028

[journal] Villa MP / 2007 / Rapid maxillary expansion in children with obstructive sleep apnea syndrome : 12-month follow-up / Sleep Med 8 : 128~134

[journal] Certal V / 2015 / Unattended sleep studies in pediatric OSA : a systematic review and meta-analysis / Laryngoscope 125 : 255~262

[journal] Vale F / 2017 / Efficacy of rapid maxillary expansion in the treatment of obstructive sleep apnea syndrome : a systematic review with meta-analysis / J Evid Based Dent Pract 17 : 159~168

[journal] Monini S / 2009 / Rapid maxillary expansion for the treatment of nasal obstruction in children younger than 12 years / Arch Otolaryngol Head Neck Surg 135 : 22~27

[journal] 원태빈 / 2013 / Contemporary Methods of Upper Airway Evaluation in Obstructive Sleep Apnea Patients / 대한이비인후-두경부외과학회지 / 대한이비인후과학회 56(1) : 7~13

[journal] Faber CE / 2003 / Available techniques for objective assessment of upper airway narrowing in snoring and sleep apnea / Sleep Breath 7 : 77~86

[journal] Major MP / 2006 / Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction : a systematic review / Am J Orthod Dentofacial Orthop 130 : 700~708

[journal] Donner MW / 1985 / Anatomy and physiology of the pharynx / Gastrointest Radiol 10 : 196~212

[journal] Katyal V / 2013 / Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion / Am J Orthod Dentofacial Orthop 144 : 860~871

[journal] Pirilä-Parkkinen K / 2011 / Validity of upper airway assessment in children : a clinical, cephalometric, and MRI study / Angle Orthod 81 : 433~439

[journal] Pracharktam N / 1994 / Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects / Angle Orthod 64 : 63~73

[journal] Bibby RE / 1984 / The hyoid bone position in mouth breathers and tongue-thrusters / Am J Orthod 85 : 431~433

[journal] Guilleminault C / 1984 / Obstructive sleep apnea and abnormal cephalometric measurements. Implications for treatment / Chest 86 : 793~794

[book] Attanasio R / 2010 / Dental management of sleep disorders / Wiley-Blackwell

[journal] Gungor AY / 2013 / Cephalometric comparison of obstructive sleep apnea patients and healthy controls / Eur J Dent 7 : 48~54

[journal] Battagel JM / 2000 / A cephalometric comparison of subjects with snoring and obstructive sleep apnoea / Eur J Orthod 22 : 353~365

[journal] Endo S / 2003 / Cephalometric evaluation of craniofacial and upper airway structures in Japanese patients with obstructive sleep apnea / J Med Dent Sci 50 : 109~120

[journal] Phoenix A / 2011 / Changes in hyoid bone position following rapid maxillary expansion in adolescents / Angle Orthod 81 : 632~638

[journal] Verin E / 2002 / Comparison between anatomy and resistance of upper airway in normal subjects, snorers and OSAS patients / Respir Physiol 129 : 335~343

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Journal of the Korean academy of pediatric dentistry 2023 KCI Impact Factor : 0.48

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

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* References for papers published after 2023 are currently being built.

Journal of the Korean academy of pediatric dentistry 2023 KCI Impact Factor : 0.48

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

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