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Maxillary Arch Expansion and Adenotonsillectomy in Prepubertal Children Diagnosed with Paediatric Obstructive Sleep
Derek Mahony1,2, Niroj Bhattarai2, Peter Petocz3
1Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Tisza Lajos Krt. 64-66., 6720 Szeged, Hungary.
Insights
Treating obstructive sleep apnoea (OSA) in children with narrow maxilla and enlarged tonsils/adenoids with combined adenotonsillectomy (TA) and semi-rapid maxillary expansion (SRME) significantly reduces the respiratory disturbance index (RDI). Treatment order impacts outcomes.
Area of Science:
- Pediatric Sleep Medicine
- Orthodontics
- Otolaryngology
Background:
- Obstructive sleep apnoea (OSA) treatment decisions in 7-9-year-olds with narrow maxilla and adenotonsillar hypertrophy remain unclear.
- Current guidelines suggest adenotonsillectomy (TA) but residual OSA is common, necessitating interest in adjunctive therapies like semi-rapid maxillary expansion (SRME).
- This study addresses the combined and individual effects of TA and SRME on respiratory disturbance index (RDI) in this specific pediatric population.
Purpose of the Study:
- To evaluate the effects of adenotonsillectomy (TA) and semi-rapid maxillary expansion (SRME) on the respiratory disturbance index (RDI) in prepubertal children with OSA.
- To compare the efficacy of TA and SRME, individually and in combination, regardless of treatment sequence.
- To investigate the influence of treatment order and BMI on RDI reduction in children with both skeletal and soft-tissue OSA contributors.
Main Methods:
- Retrospective cohort study of 80 children (aged 7-9 years) with polysomnography-confirmed OSA, narrow maxilla, and adenotonsillar enlargement.
- Children received either TA followed by SRME (n=39) or SRME followed by TA (n=41).
- Level 1 polysomnography was conducted at baseline and 3 months post-intervention; repeated-measures analyses adjusted for BMI and other variables.
Main Results:
- Baseline mean RDI was 18.99 ± 1.66 events/hour.
- Initial RDI reduction was significantly greater after SRME compared to TA (adjusted mean difference 1.49 events/hour, p=0.002).
- This difference in RDI reduction persisted after both treatments were completed (adjusted mean difference 1.42, p=0.007), indicating SRME's greater initial impact.
Conclusions:
- Combined TA and SRME significantly reduce RDI in children with combined soft-tissue and skeletal OSA contributors.
- The order of treatment (TA then SRME, or SRME then TA) and BMI are significantly associated with final RDI outcomes.
- A flexible, multidisciplinary approach is recommended for optimizing airway management and minimizing residual OSA in this pediatric population.
Abstract:
Background: In many children aged 7-9 years diagnosed with obstructive sleep apnoea (OSA) the decision of which treatment to perform still remains unclear. This is particularly relevant when the children have both a narrow maxilla and enlargement of tonsils and adenoids. Current guidelines recommend adenotonsillectomy (TA) as first-line therapy, but residual OSA is common, prompting interest in adjunctive semi-rapid maxillary expansion (SRME). This study evaluated the effects of TA and SRME on the respiratory disturbance index (RDI) in prepubertal children with OSA, both individually and in combination, regardless of treatment sequence. Materials and Methods: In this retrospective cohort study, 80 children (aged 7-9 years) with polysomnography-confirmed obstructive sleep apnoea, narrow maxillary arches, and adenotonsillar enlargement underwent TA first followed by SRME (n = 39) or SRME first followed by TA (n = 41). Level 1 polysomnography was performed at baseline and 3 months after each intervention. Repeated-measures analyses investigated the RDI profiles of the two groups over time, in each case adjusting for relevant background variables. Results: Baseline mean RDI was 18.99 ± 1.66 events/hour. Adjusted for background variables (including, most importantly, BMI), the initial reduction was significantly greater after SRME than TA (adjusted mean difference 1.49 events/hour, p = 0.002), and this difference persisted until after both treatments were applied (adjusted mean difference 1.42, p = 0.007). Conclusions: Combined TA and SRME produced substantial RDI reductions compared to individual interventions in children with dual soft-tissue and skeletal OSA contributors, with treatment order (as well as BMI) significantly associated with different final outcomes. These findings support a flexible, multidisciplinary approach to optimise airway management and reduce residual disease.
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