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Comparison of the effects of Adenotonsillectomy and Rapid Maxillary Expansion on obstructive sleep apnea in children - Prospective Randomized Controlled Trial.


Obstructive Sleep Apnea (OSA) affects about 2% of pre-school children and is associated with different comorbidities, some of which have implications in adult life. It is an under-diagnosed and under-treated disease.


To evaluate the effect of rapid maxillary expansion (RME) and adenotonsillectomy (ADT) on the subjective and objective parameters of sleep, echocardiography, spirometry and quality of life of infant with obstructive sleep apnea.


Children with adenoid and tonsil hypertrophy grade III and IV, with complaints of snoring and respiratory arrest at night and craniofacial alterations that favored the RME were consecutively selected in the otorhinolaryngology clinic of the Federal University of Uberlândia.The children were submitted to polysomnography (PSG), those with AHI ≥ 2 were selected and randomized by individual lottery in two groups: ADT (n=13) and RME (n=17). PSG and spirometry examinations were performed by trained technicians.The echocardiogram was performed by cardiologists. The questionnaires OSA-18 and SBQ were applied by dentists. All reports were made by examining physicians and blinded for both the pathology being investigated and the time of treatment the child was in. The exams and questionnaires were applied before and after 4 months of the interventions.


The sample consisted of 30 children, of whom 15 were male, aged 8 ± 2 years; BMI: 18.5 ± 4.7 kg / m 2. After the therapeutic interventions, there was a significant improvement in AHI (p <0.001 / p = 0.003 / p = 0.007), saturation (p = 0.01 / p = 0.006 / p = 0.03), quality of life (p <0.001 / p <0.001 / p = 0.04) and sleep behavior (p = 0.01 / p = 0.009 / p = 0.60) for the total sample, ADT and RME respectively. However, only 46% of the patients submitted to surgery and 23% of those submitted to orthodontic treatment had normalization of the AHI after the intervention. When comparing the two interventions, therapeutic superiority was observed for adenotonsillectomy in the parameters of total score (0.01), symptoms during sleep (P = 0.01), and the informant's opinion (p = 0.005) of OSA-18, as well as in the total SBQ score (p = 0.009).


Both treatments reduce AHI significantly, but for children with craniofacial changes and grade III or IV tonsil hypertrophy, only one of the interventions failed to normalize all polysomnographic parameters. The overlap of therapies and multiprofessional care is recommended.


Tonsillectomy; Maxillary Expansion; Treatment; Obstructive Sleep Apnea; Infant


Área Clínica


Faculdade de Medicina - Universidade Federal de São Paulo - Sao Paulo - Brasil, Faculdade de Medicina - Universidade Federal de Uberlandia - Minas Gerais - Brasil, Faculdade de Odontologia - Universidade Federal de Uberlandia - Minas Gerais - Brasil


Thays Crosara Abrahão Cunha, Lia Rita Azeredo Bittencourt, Thulio Marquez Cunha, Lurdes de Fátima Goncalvez Gomes, Fernanda Bacchin, Ricardo Maurício Novaes, Guilherme Araújo Almeida, Paulo Cezar Simamoto - Júnior