Rapid maxillary expansion in paediatric obstructive sleep apnoea.

We thank Marcos Fernández-Barriales and colleagues for their comments on the summary of orthodontic approaches that we provided in our Personal View of Sept 23, 2022.1Ersu R Chen ML Ehsan Z Ishman SL Redline S Narang I Persistent obstructive sleep apnoea in children: treatment options and management considerations.Lancet Respir Med. 2023; 11: 283-296Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar Although we agree that there is no definitive evidence on specific craniofacial features that predispose to obstructive sleep apnoea (OSA) in children, as highlighted in a systematic review (which itself was limited by low sample sizes of a few uncontrolled studies),2Fagundes NCF Gianoni-Capenakas S Heo G Flores-Mir C Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis.J Clin Sleep Med. 2022; 18: 1865-1875Crossref PubMed Scopus (6) Google Scholar this hypothesis cannot and should not be dismissed prematurely. Recent data have shown that increased maxillary–mandibular relationship angle obtained from facial surface geometric analysis using photogrammetry appears to be associated with OSA in children.3Yuen HM Chan KCC Chu WCW et al.Craniofacial phenotyping by photogrammetry in Chinese prepubertal children with obstructive sleep apnea.Sleep. 2023; 46zsac289 Crossref PubMed Scopus (3) Google Scholar Similarly, data from adults with OSA have shown that mandibular width–length angle, evaluated using 3D photogrammetry, can predict the presence and severity of OSA.4Ohmura K Suzuki M Soma M et al.Predicting the presence and severity of obstructive sleep apnea based on mandibular measurements using quantitative analysis of facial profiles via three-dimensional photogrammetry.Respir Investig. 2022; 60: 300-308Crossref PubMed Scopus (1) Google Scholar We do align with the observations of Fernández-Barriales and colleagues that it is not clear whether these changes in craniofacial morphology are amenable to orthodontic treatment and, thus, evidence on the efficacy of OSA management on dental and craniofacial structures requires concerted efforts longitudinally.1Ersu R Chen ML Ehsan Z Ishman SL Redline S Narang I Persistent obstructive sleep apnoea in children: treatment options and management considerations.Lancet Respir Med. 2023; 11: 283-296Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar On the subject of rapid maxillary expansion (RME), we agree with Fernández-Barriales and colleagues that the evidence on RME treatment for paediatric OSA is limited, as observed in uncontrolled studies in children before adenotonsillectomy.4Ohmura K Suzuki M Soma M et al.Predicting the presence and severity of obstructive sleep apnea based on mandibular measurements using quantitative analysis of facial profiles via three-dimensional photogrammetry.Respir Investig. 2022; 60: 300-308Crossref PubMed Scopus (1) Google Scholar We consider in our Personal View that RME might be more effective after adenotosillectomy,5Xie B Zhang L Lu Y The role of rapid maxillary expansion in pediatric obstructive sleep apnea: efficacy, mechanism and multidisciplinary collaboration.Sleep Med Rev. 2023; 67101733 Crossref PubMed Scopus (1) Google Scholar as an adjunct to other treatments such as continuous positive airway pressure, potentially reducing pressure needs and improving adherence, although its use as an adjunct therapy has yet to be evaluated.1Ersu R Chen ML Ehsan Z Ishman SL Redline S Narang I Persistent obstructive sleep apnoea in children: treatment options and management considerations.Lancet Respir Med. 2023; 11: 283-296Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar Importantly, our Personal View1Ersu R Chen ML Ehsan Z Ishman SL Redline S Narang I Persistent obstructive sleep apnoea in children: treatment options and management considerations.Lancet Respir Med. 2023; 11: 283-296Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar underscores the need for clinical trials and high-level evidence to inform the management of OSA before and after adenotonsillectomy in children. SLI reports a research grant from Inspire Medical. SR is the recipient of an Outstanding Investigator Award from the National Institutes of Health (NIH). SR has received consulting fees from Jazz Pharma, Eisai, Eli Lilly, and Apnimed; serves on the scientific advisory board for Apnimed; and received reimbursement for attending a meeting with an Eisai scientific advisory board in January, 2019. SR reports that her institution received loaned equipment for use in an NIH study from Philips Respironics and NOX Medical. SR is on the board for the non-profit patient advocacy group Alliance for Sleep Apnea Partners. IN has received consulting fees from Bayer. The other authors declare no competing interests. Persistent obstructive sleep apnoea in children: treatment options and management considerationsUnresolved obstructive sleep apnoea (OSA) after an adenotonsillectomy, henceforth referred to as persistent OSA, is increasingly recognised in children (2–18 years). Although associated with obesity, underlying medical complexity, and craniofacial disorders, persistent OSA also occurs in otherwise healthy children. Inadequate treatment of persistent OSA can lead to long-term adverse health outcomes beyond childhood. Positive airway pressure, used as a one-size-fits-all primary management strategy for persistent childhood OSA, is highly efficacious but has unacceptably low adherence rates. Full-Text PDF Rapid maxillary expansion in paediatric obstructive sleep apnoeaWe read with great interest the Personal View by Refika Ersu and colleagues, published in The Lancet Respiratory Medicine on Sept 23, 2022.1 The authors gave their expert opinion on the available treatment strategies for persistent paediatric obstructive sleep apnoea (OSA) after adenotonsillectomy. We appreciate the efforts of the authors to shed light on this underestimated clinical entity; however, we are concerned that new data published throughout the past year might limit their summary on orthodontic approaches. Full-Text PDF