Sleep disordered breathing symptoms in children: a prospective evaluation 5 years after maxillary expansion

To investigate the effects of maxillary expansion and of different types of subsequent comprehensive orthodontic treatment on sleep disordered breathing (SDB) symptoms in children five years after maxillary expansion.

Children needing early maxillary expansion were asked to fill the Pediatric Sleep Questionnaire (PSQ) at three time points: before the start of maxillary expansion (T0; N = 404), after active expansion (T1; N = 309) and after the completion of comprehensive orthodontic treatment (T2; N = 113). Maxillary expansion was achieved using a removable expansion plate (80,49 %), a hyrax (18,03 %) or a quadhelix (1,48 %). When indicated, comprehensive orthodontic treatment either consisted of fixed appliances alone or was combined with a class II functional appliance, a headgear or a hyrax. Linear mixed models corrected for age were used to compare the PSQ results per time point.

Significant reductions in the total PSQ scores (p < 0.0001), breathing (p < 0.0001), behavior (p = 0.0026) and loudness of snoring (p = 0.0107) were observed between T0 and T1, which maintained between T0 and T2 (p = 0.0275; p = 0.0281; p = 0.0243). Between T1 and T2 and T0 and T2, sleepiness significantly increased (p < 0.0001; p = 0.0004). No significant interaction was found between the four different types of comprehensive orthodontic treatment and the PSQ scores.

Early maxillary expansion with removable plates has general a positive effect on PSQ scores. These improvements exhibit a stability for at least five years, regardless of the type of subsequent comprehensive orthodontic treatment. Therefore, the orthodontist plays an important role in the early detection and multidisciplinary treatment of pediatric obstructive sleep apnea syndrome.