Mini-implant Assisted Rapid Palatal Expansion (MARPE) Effects on Adult Obstructive Sleep Apnea (OSA) and Quality of Life: a Multi-center Prospective Controlled Trial

Overview

Journal Prog Orthod

Publisher Springer

Specialty Dentistry

Date 2022 Feb 1

PMID 35102477

Authors

Daniel Paludo Brunetto

Christoph E Moschik

Ramon Dominguez-Mompell

Eliza Jaria

Eduardo Franzotti SantAnna

Won Moon

Affiliations

Soon will be listed here.

Abstract

Introduction: Transverse maxillary deficiency is a high prevalent growth disorder within the adult population that may lead to serious health issues, such as detrimental malocclusions and higher risk of developing obstructive sleep apnea (OSA). Mini-implant assisted rapid palatal expansion (MARPE), as it expands the mid-face and augment the nasal and oral cavities dimensions, may reduce the airflow resistance and thus play an important role on OSA therapy in some patients. The main objective of the present trial is to assess MARPE effects on the sleep and quality of life of non-obese adult OSA patients with transverse maxillary deficiency.

Methods: A total of 32 participants were divided into intervention and control groups. They underwent physical evaluation, Epworth Sleepiness Scale (EES) and Quebec Sleep Questionnaire (QSQ), cone-beam computed tomography (CBCT) and home sleep testing (HST) for OSA before MARPE (T1) and 6 months after the intervention (T2).

Results: Questionnaires EES (daytime sleepiness) and QSQ (OSA-related quality of life) presented significant statistical differences between the groups. We also found clinical and statistical (p < 0.01) differences between the groups regarding the apnea/hypopnea index (AHI), as well as others HST parameters (mean oxygen saturation and snoring duration).

Conclusion: In our sample, MARPE (without any auxiliary osteotomy) showed a good success rate (85%) and promoted important occlusal and respiratory benefits. We observed important daytime sleepiness and OSA-related quality of life improvement, as well as the AHI (65.3%), oxygen saturation and snoring duration.

Citing Articles

The Role of Rapid Maxillary Expansion in the Management of Obstructive Sleep Apnoea: Monitoring Respiratory Parameters-A Systematic Review and Meta-Analysis.

Hariharan A, Muwaquet Rodriguez S, Hijazi Alsadi T J Clin Med. 2025; 14(1.

PMID: 39797199 PMC: 11720855. DOI: 10.3390/jcm14010116.

The Clinical Management of Traumatic Palatal Ulcers in an Adolescent Patient: A Common Lesion in Mini-Implant-Assisted Rapid Maxillary Expansion.

Barriga C, Munoz G, Sandoval P, Lara A, Copello F Medicina (Kaunas). 2024; 60(11).

PMID: 39596968 PMC: 11596309. DOI: 10.3390/medicina60111784.

Miniscrew-Assisted Rapid Palatal Expansion: A Scoping Review of Influencing Factors, Side Effects, and Soft Tissue Alterations.

Labunet A, Iosif C, Kui A, Vigu A, Sava S Biomedicines. 2024; 12(11).

PMID: 39595004 PMC: 11591991. DOI: 10.3390/biomedicines12112438.

Effect of Anchorage Modifications on the Efficacy of Miniscrew-Assisted Rapid Palatal Expansion: A Systematic Review and Meta-Analysis.

Villa-Obando Y, Correa-Osorio S, Castrillon-Marin R, Vivares-Builes A, Ardila C Cureus. 2024; 16(10):e72008.

PMID: 39569259 PMC: 11577497. DOI: 10.7759/cureus.72008.

The role of orthodontists in the multidisciplinary management of obstructive sleep apnea.

Faber J, Mota A, Ho L, Darendeliler M Prog Orthod. 2024; 25(1):40.

PMID: 39489836 PMC: 11532327. DOI: 10.1186/s40510-024-00541-3.

References

Pankow W, Lies A, LOHMANN F . Sleep-disordered breathing and hypertension. N Engl J Med. 2000; 343(13):966; author reply 967. DOI: 10.1056/NEJM200009283431310. View

Hu F, Willett W, Manson J, Colditz G, Rimm E, Speizer F . Snoring and risk of cardiovascular disease in women. J Am Coll Cardiol. 2000; 35(2):308-13. DOI: 10.1016/s0735-1097(99)00540-9. View

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328(17):1230-5. DOI: 10.1056/NEJM199304293281704. View

Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N . Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015; 3(4):310-8. PMC: 4404207. DOI: 10.1016/S2213-2600(15)00043-0. View

Otake K, Delaive K, Walld R, Manfreda J, Kryger M . Cardiovascular medication use in patients with undiagnosed obstructive sleep apnoea. Thorax. 2002; 57(5):417-22. PMC: 1746332. DOI: 10.1136/thorax.57.5.417. View

Leger D, Bayon V, Laaban J, Philip P . Impact of sleep apnea on economics. Sleep Med Rev. 2012; 16(5):455-62. DOI: 10.1016/j.smrv.2011.10.001. View

Rosen C, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Kapur V . A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep. 2012; 35(6):757-67. PMC: 3353048. DOI: 10.5665/sleep.1870. View

Kuna S, Gurubhagavatula I, Maislin G, Hin S, Hartwig K, McCloskey S . Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med. 2011; 183(9):1238-44. DOI: 10.1164/rccm.201011-1770OC. View

Xu L, Han F, Keenan B, Kneeland-Szanto E, Yan H, Dong X . Validation of the Nox-T3 Portable Monitor for Diagnosis of Obstructive Sleep Apnea in Chinese Adults. J Clin Sleep Med. 2017; 13(5):675-683. PMC: 5406954. DOI: 10.5664/jcsm.6582. View

10.

Anandam A, Patil M, Akinnusi M, Jaoude P, El-Solh A . Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: an observational study. Respirology. 2013; 18(8):1184-90. DOI: 10.1111/resp.12140. View

11.

Knudsen T, Laulund A, Ingerslev J, Homoe P, Pinholt E . Improved apnea-hypopnea index and lowest oxygen saturation after maxillomandibular advancement with or without counterclockwise rotation in patients with obstructive sleep apnea: a meta-analysis. J Oral Maxillofac Surg. 2014; 73(4):719-26. DOI: 10.1016/j.joms.2014.08.006. View

12.

Villa M, Rizzoli A, Rabasco J, Vitelli O, Pietropaoli N, Cecili M . Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children. Sleep Med. 2015; 16(6):709-16. DOI: 10.1016/j.sleep.2014.11.019. View

13.

Pirelli P, Saponara M, Guilleminault C . Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up. Sleep Med. 2015; 16(8):933-5. DOI: 10.1016/j.sleep.2015.04.012. View

14.

Machado-Junior A, Zancanella E, Crespo A . Rapid maxillary expansion and obstructive sleep apnea: A review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2016; 21(4):e465-9. PMC: 4920460. DOI: 10.4317/medoral.21073. View

15.

Vinha P, Eckeli A, Faria A, Xavier S, De Mello-Filho F . Effects of surgically assisted rapid maxillary expansion on obstructive sleep apnea and daytime sleepiness. Sleep Breath. 2015; 20(2):501-8. DOI: 10.1007/s11325-015-1214-y. View

16.

Cantarella D, Dominguez-Mompell R, Mallya S, Moschik C, Pan H, Miller J . Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging. Prog Orthod. 2017; 18(1):34. PMC: 5663987. DOI: 10.1186/s40510-017-0188-7. View

17.

Choi S, Shi K, Cha J, Park Y, Lee K . Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults. Angle Orthod. 2016; 86(5):713-20. PMC: 8600851. DOI: 10.2319/101415-689.1. View

18.

Levendowski D, Steward D, Woodson B, Olmstead R, Popovic D, Westbrook P . The impact of obstructive sleep apnea variability measured in-lab versus in-home on sample size calculations. Int Arch Med. 2009; 2(1):2. PMC: 2639556. DOI: 10.1186/1755-7682-2-2. View

19.

Duran-Cantolla J, Crovetto-Martinez R, Alkhraisat M, Crovetto M, Municio A, Kutz R . Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: A randomized controlled crossover clinical trial. Med Oral Patol Oral Cir Bucal. 2015; 20(5):e605-15. PMC: 4598931. DOI: 10.4317/medoral.20649. View

20.

Ben-Noun L, SOHAR E, Laor A . Neck circumference as a simple screening measure for identifying overweight and obese patients. Obes Res. 2001; 9(8):470-7. DOI: 10.1038/oby.2001.61. View