Childhood obstructive sleep apnea syndrome (OSAS) is an important risk factor for childhood developmental disorders, metabolic disorders and inflammation. 1.2 to 5.8% of the general pediatric population have OSAS. OSAS can have different levels of severity that could give rise to long term effects on children including alterations in behavior and neurocognitive deficits affecting attention, learning and memory as well as executive and motor functions.
A review of rapid maxillary expansion (RME) as the treatment for obstructive sleep apnea syndrome (OSAS) in children less than 18 years-old who did and did not have their tonsils removed showed a decrease of 66.1% in the Apnea Hypopnea Index (AHI).
The Apnea Hypopnea Index (AHI) is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (periods of shallow breathing) that occur, on average, each hour. The AHI is calculated by dividing the number of events by the number of hours of sleep.
Obstructive sleep apnea syndrome (OSAS) is caused by a protracted partial upper airway obstruction (hypopnea) and/or an intermittent complete obstruction (apnea). Having this disorder could cause a number of disruptions to sleep that could cause a cessation in breathing, decrease in oxygen saturation and increase the number of arousals, as well as severe impairments in cognitive function.
While obesity is considered to be a major cause of OSAS in adults, adenotonsillar hypertrophy (ATH) which may increase airways resistance, is thought to be the prime cause of childhood OSAS. In literature it is seen that ATH leads not only to problems related to mouth breathing, snoring, chronic sinusitis, nasal congestion, hyponasal speech, but also to emotional disorders and poor neurological development.
On a mean follow-up duration of 3 years, a decrease of 66.1% of AHI was detected in all of the 102 children with OSAS that underwent RME treatment, with or without tonsillectomy and adenoidectomy. A larger AHI reduction was observed in children with small tonsils (97.7%) or no tonsils (82.4%) rather than large tonsils (56.4%). This data highlighted the importance of tonsillectomy and adenoidectomy combined with RME treatment. Furthermore, a general improvement of the daytime and nighttime symptoms of OSAS after RME therapy was documented in all the studies considered, demonstrating that rapid maxillary expansion was an effective treatment for obstructive sleep apnea syndrome.
