A clinical trial on 3D CT scan and polysomnographyc changes after rapid maxillary expansion in children with snoring

Bariani, Rita Catia Brás; Bigliazzi, Renato; Badreddine, Fauze Ramez; Yamamoto, Lucia Hatsue; Tufik, Sergio; Moreira, Gustavo; Fujita, Reginaldo Raimundo

doi:10.1016/j.bjorl.2022.04.004

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Brazilian Journal of Otorhinolaryngology

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ORIGINAL ARTICLE • Braz. j. otorhinolaryngol. 88 (suppl 5) • Nov-Dec 2022 • https://doi.org/10.1016/j.bjorl.2022.04.004 copy

A clinical trial on 3D CT scan and polysomnographyc changes after rapid maxillary expansion in children with snoring

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The present prospective clinical study aimed to investigate the effects of rapid maxillary expansion on the airway, correlating airway volumes obtained on multi-slice computed tomography and polysomnography assessment of oxygen saturation and apnea/hypopnea index.

Methods:

Twenty-four patients (11 with obstructive sleep apnea and 13 with residual snoring, mean age 10.0 (1.8), were enrolled in the study. Each patient underwent multislice computed tomography and nocturnal polysomnography before rapid maxillary expansion and after removal of maxillary expansion after six months. Airway regions were segmented, and volumes were computed.

Results:

The increase in oropharyngeal volume was significant in both groups. Oxygen saturation and apnea/hypopnea index were not statistically significant. No correlation was found between total airway volume, oxygen saturation, and apnea/hypopnea index changes between the time points examined.

Conclusions:

This study showed that when rapid maxillary expansion is performed in individuals with sleep-disordered breathing, there were statistically significant differences in oropharyngeal volume between pre- and post-rapid maxillary expansion, but there was no correlation between oxygen saturation values and oropharyngeal volume increase.

Level of evidence:

The article is classified as Evidence Level 3 (Three).

KEYWORDS
Sleep apnea, obstructive; Palatal expansion technique; Imaging,; three-dimensional; Craniofacial abnormalities; Sleep apnea syndromes

HIGHLIGHTS

RME should be a treatment option in children with SBT and maxillary hypoplasia.

The oropharynx volume increased after rapid maxillary expansion.

Differences in oropharyngeal volume between pre- and post RME in individuals with SDB.

Variables		Baseline	6-months after treatment	Student t-test
Age (years)	Min – Max	6.1 – 12.7	6.8 – 14.6	p < 0.001
Age (years)	Mean (SD)	10.0 (1.8)	11.3 (1.9)	p < 0.001
Weight (Kg)	Min – Max	19 – 61	21–70	p < 0.001
Weight (Kg)	Mean (SD)	36.0 (9.0)	40.9 (10.5)	p < 0.001
Height (meters)	Min – Max	0.97 – 1.55	1.10 – 1.60	p < 0.001
Height (meters)	Mean (SD)	1.36 (0.14)	1.46 (0.12)	p < 0.001
BMI (Z-score for age)	Min – Max	−2.13 – 5.21	− 3.09 – 3.28	p = 0.098
BMI (Z-score for age)	Mean (SD)	0.87(2.16)	0.37(1.76)	p = 0.098
Sex	Female	n = 8 (33.3%)
Sex	Male	n= 16 (66.7%)

Variables	Group	Pre-RME M (SD)	Post-RME M (SD)	Difference in dimension (d)	p Pre-Post	p interaction group*time
AHI	Total	1.49 (1.32)	2.07 (2.85)	0.22	0.289	0.352
	Primary snoring	0.83 (1.08)	1.87 (3.65)	0.32	0.266
	OSA	2.26 (1.19)	2.33 (1.41)	0.05	1.000
	group p	0.005	0.710
OAHI	Total	1.07 (1.09)	1.23 (1.47)	0.11	0.570	0.095
	Primary snoring	0.37 (0.30)	1.08 (1.67)	0.46	0.124
	OSA	1.89 (1.12)	1.42 (1.22)	0.43	0.163
	group p	<0.001	0.599
CAHI	Total	0.43 (0.70)	0.73 (1.54)	0.21	0.338	0.983
	Primary snoring	0.48 (0.84)	0.76 (2.03)	0.16	0.585
	OSA	0.36 (0.52)	0.68 (0.56)	0.47	0.205
	group p	0.684	0.904
RDI	Total	1.60 (1.39)	1.98 (2.82)	0.14	0.489	0.236
	Primary snoring	0.94 (1.13)	1.91 (3.64)	0.30	0.300
	OSA	2.37 (1.29)	2.07 (1.30)	0.21	0.431
	group p	0.008	0.895
Basal SpO₂	Total	96.43 (0.94)	96.29 (1.37)	0.12	0.508	0.213
	Primary snoring	96.71 (0.87)	96.82 (0.89)	0.14	0.629
	OSA	96.11 (0.96)	95.60 (1.62)	0.33	0.309
	group p	0.124	0.032
Mean SpO₂	Total	95.60 (1.26)	95.12 (1.67)	0.37	0.104	0.930
	Primary snoring	96.00 (1.18)	95.57 (1.66)	0.38	0.191
	OSA	95.12 (1.22)	94.54 (1.57)	0.38	0.346
	group p	0.087	0.146
Min SpO₂	Total	90.83 (3.03)	91.00 (2.75)	0.06	0.749	0.243
	Primary snoring	92.54 (1.81)	92.15 (1.82)	0.16	0.568
	OSA	88.82 (2.99)	89.50 (3.10)	0.25	0.331
	group p	0.001	0.018
DI	Total	1.28 (1.25)	1.54 (1.60)	0.19	0.315	0.620
	Primary snoring	0.63 (0.92)	0.79 (0.98)	0.15	0.594
	OSA	2.05 (1.17)	2.52 (1.75)	0.28	0.419
	group p	0.003	0.007

Variables	Group	Pre-RME M (SD)	Post-RME M (SD)	Difference dimension (d)	p Pre-Post	p interaction group*time
Volume	Total	8656.09 (12498.82)	10631.71 (14793.89)	0.72	0.002	0.218
	Primary Snoring	11098.34 (16673.82)	13723.33 (19683.44)	0.82	0.012
	OSA	5769.80 (2961.41)	6977.98 (3367.60)	0.61	0.072
	p groups	0.308	0.275

Variables	Group	Pre-RME M (SD)	Post-RME M (SD)	Difference dimension (d)	p Pre-Post	p interaction group*time
Mean Sat. awake	Total	96.49 (0.94)	96.20 (1.29)	0.26	0.213	0.412
	Primary snoring	96.81 (0.82)	96.69 (0.82)	0.15	0.593
	OSA	96.12 (0.96)	95.62 (1.53)	0.35	0.277
	p groups	0.071	0.040
Mean Sat. REM	Total	95.90 (1.31)	95.47 (1.37)	0.34	0.108	0.697
	Primary snoring	96.32 (1.18)	95.99 (0.86)	0.48	0.107
	OSA	95.39 (1.32)	94.86 (1.64)	0.31	0.328
	p groups	0.081	0.040
Mean Sat. NREM	Total	95.55 (1.28)	95.17 (1.31)	0.33	0.120	0.597
	Primary snoring	95.95 (1.23)	95.68 (0.95)	0.28	0.333
	OSA	95.08 (1.22)	94.56 (1.46)	0.37	0.246
	p groups	0.100	0.034
Total desat	Total	8.00 (7.66)	12.38 (17.08)	0.27	0.195	0.636
	Primary snoring	3.69 (4.92)	9.54 (20.00)	0.31	0.288
	OSA	13.09 (7.29)	15.73 (12.98)	0.21	0.498
	p groups	0.001	0.388
SDI	Total	1.29 (1.24)	2.00 (2.78)	0.27	0.197	0.566
	Primary snoring	0.65 (0.91)	1.64 (3.48)	0.31	0.292
	OSA	2.05 (1.17)	2.42 (1.69)	0.22	0.474
	p groups	0.003	0.506
SDI REM	Total	2.07 (3.38)	2.99 (4.31)	0.21	0.313	0.936
	Primary snoring	0.86 (1.34)	1.85 (3.13)	0.27	0.354
	OSA	3.50 (4.46)	4.34 (5.22)	0.16	0.607
	p groups	0.054	0.163
SDI NREM	Total	1.06 (1.06)	1.65 (2.73)	0.24	0.251	0.474
	Primary snoring	0.58 (0.94)	1.52 (3.62)	0.29	0.315
	OSA	1.62 (0.94)	1.81 (1.17)	0.17	0.590
	p groups	0.014	0.805
OAHI SUPINE	Total	2.77 (4.51)	1.96 (3.05)	0.16	0.451	0.994
	Primary snoring	2.52 (5.66)	1.71 (3.72)	0.12	0.676
	OSA	3.05 (2.85)	2.25 (2.15)	0.36	0.266
	p groups	0.781	0.672
OAHI NON-SUPINE	Total	1.27 (1.25)	1.67 (3.02)	0.13	0.592	0.103
	Primary snoring	0.66 (1.05)	2.03 (4.05)	0.36	0.253
	OSA	1.99 (1.11)	1.26 (1.30)	0.57	0.086
	p groups	0.007	0.554

Saturation	Oropharyngeal volume
Saturation	Before RME	After RME
Mean Sat. awake	R = −0.207^a a p> 0.05 (coefficients not significantly different from zero).	R = 0.062^a a p> 0.05 (coefficients not significantly different from zero).
Mean Sat. REM	R = −0.245^a a p> 0.05 (coefficients not significantly different from zero).	R = −0.141^a a p> 0.05 (coefficients not significantly different from zero).
Mean Sat. NREM	R = −0.253^a a p> 0.05 (coefficients not significantly different from zero).	R = −0.040^a a p> 0.05 (coefficients not significantly different from zero).
Total desat	R = −0.180^a a p> 0.05 (coefficients not significantly different from zero).	R = −0.198^a a p> 0.05 (coefficients not significantly different from zero).
SDI	R= −0.148^a a p> 0.05 (coefficients not significantly different from zero).	R = −0.195^a a p> 0.05 (coefficients not significantly different from zero).
SDI REM	R= −0.049^a a p> 0.05 (coefficients not significantly different from zero).	R = −0.164^a a p> 0.05 (coefficients not significantly different from zero).
SDI NREM	R= −0.202^a a p> 0.05 (coefficients not significantly different from zero).	R = −0.178^a a p> 0.05 (coefficients not significantly different from zero).
OAHI SUPINE	R= −0.136^a a p> 0.05 (coefficients not significantly different from zero).	R = −0.147^a a p> 0.05 (coefficients not significantly different from zero).
OAHI NON-SUPINE	R= −0.108^a a p> 0.05 (coefficients not significantly different from zero).	R = −0.139^a a p> 0.05 (coefficients not significantly different from zero).

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] *Corresponding author. E-mail:ritabariani@hotmail.com (R.C. Bariani).