Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion

The precise role of maxillary constriction in the pathophysiology of obstru ctive sleep apnea (OSA) is unclear. However, it is known that subjects with maxillary construction have increased nasal resistance and resultant mouth -breathing, features typically seen in OSA patients. Maxillary constriction is also associated with alterations in tongue posture which could result i n retroglossal airway narrowing, another feature of OSA. Rapid maxillary ex pansion (RME) is an orthodontic treatment for maxillary constriction which increases the width of the maxilla and reduces nasal resistance. The aim of this pilot study was to investigate the effect of rapid maxillary expansio n in OSA. We studied 10 young adults (8 male, 2 female, mean age 27+/-2 [se m] years) with mild to moderate OSA(apnea/hypopnea index-AHI 19+/-4 and min imum SaO(2) 89+/-1%), and evidence of maxillary constriction on orthodontic evaluation. Ail patients underwent treatment with RME, six cases requiring elective surgical assistance. Polysomnography was repealed at the completi on of treatment. Nine of the 10 patients reported improvements in snoring a nd hypersomnolence. There was a significant reduction in AHI (19+/-4 vs 7+/ -4, p<0.05) in the entire group. In seven patients, the AHI returned to nor mal (ie, =<5); only one patient showed no improvement. These preliminary da ta suggest that RME may be a useful treatment alternative for selected pati ents with OSA.