Assessment of Response to Rapid Maxillary Expansion in Pediatric Sleep-Disordered Breathing

Hypotheses: 1. There is no mean difference in study variables between surgical and non-surgical subjects based on Pediatric Sleep Questionnaire (PSQ) and Sleep-Related Breathing Disorders (SRBD) risk. 2. There is no relationship between cephalometric variables and response to rapid maxillary expansion (RME) as measured by change in PSQ scores. Objective: To investigate the difference in study variables between surgical and non-surgical pediatric subjects with SRBD after RME treatment. Methods: Subjects were referred to an orthodontist by ENT physicians due to airway/sleep-related symptoms and treated with RME. Lateral cephalograms were taken at baseline. PSQs were administered to caregivers at baseline and again after RME removal to measure subjects’ response to treatment. Subjects were divided into two groups: surgical - had tonsillectomy and adenoidectomy (T&A) performed (n=15), and non-surgical - did not have T&A performed (n=43). The subjects were further classified into subgroups positive responders and non-responders based on PSQ scores and the percentage change in the score from baseline. Results: Independent Student’s t-tests indicated statistically significant mean differences in the cephalometric variables ANB(°), PAS(mm), and PNS-ad2(mm) between the two study groups non-surgical positive responders (n=37) and surgical positive responders (n=13). Statistically significant mean differences were also found in the variables facial axis(°) and PAS(mm) between high-risk non-surgical positive responders (n=14) and high-risk surgical positive responders (n=9). The Pearson correlation test did not show a statistically significant correlation between any of the cephalometric variables and the percentage change in the total PSQ-SRBD score from baseline. Conclusions: Positive responders who had undergone T&A had higher mean ANB, lower mean PAS, and higher mean PNS-ad2 measurements. For SRBD high-risk positive responders, those who had undergone T&A had lower mean facial axis and PAS measurements. Baseline cephalometric variables may be employed as a screening tool in determining response to RME. Funding: N/A IRB protocol: 2017-0111