Rapid Maxillary Expansion and Protraction Alleviates Obstructive Sleep Apnea in Non-Syndromic Children with Cleft Palate

Background and Objective: Cleft palate with or without cleft lip (CP/L) is commonly associated with obstructive sleep apnea (OSA), but few studies exist which evaluate the presence of OSA in these children. Individuals with CP/L frequently suffer from severe maxillary constriction, an anatomical characteristic frequently found in OSA individuals. Rapid maxillary expansion (RME) is an orthodontic treatment approach that increases maxillary skeletal dimensions via expansion at the mid-palatal suture. This effect has been shown to reduce nasal airway resistance in previous studies, suggesting the use of RME as a potential treatment modality for pediatric OSA. However, Children with CP/L have a comparatively more complex etiology of upper airway obstruction and the efficacy of RME for treating OSA in individuals with CP/L has not been evaluated. Materials and Methods: Twenty-four subjects between 6-12 years old with cleft palate with or without cleft lip requiring maxillary palatal expansion prior to alveolar bone grafting were recruited prospectively. Validated 22- item pediatric sleep questionnaires (PSQ) were given pre- and post-treatment with RME and were used to assess the risk of OSA in the patients. Cone beam computed tomography (CBCT) data was utilized to evaluate minimum cross sectional area using 3dMDvultus software (Atlanta, U.S.A).Results: The volumetric data, as well as standard lateral cephalogram and transverse measurements were related to the scores on the PSQs. 29.2% of the recruited subjects met criteria for OSA on their pre-treatment PSQs, and those with OSA had a significant decrease in their scores post-treatment. The Minimal Cross Section of the airway (MCA), lateral cephalograms and transverse measurements did not correlate with the PSQ scores.Conclusions: Almost 30% of the pediatric subjects with cleft palate with or without cleft lip in our study were at high risk for OSA prior to orthodontic treatment, approximately 10 – 20 times the reported prevalence in the general pediatric population. RME and maxillary protraction treatment appears to improve symptoms of sleep disordered breathing in young subjects with cleft palate with or without cleft lip. Other than pediatric sleep questionnaires, the airway measurements from the three-dimensional imaging and lateral cephalograms did not appear to correlate with the pediatric sleep questionnaires and the patient’s risk for obstructive sleep apnea