There has been a great deal in the current literature concerning airways, pediatric obstructive sleep apnea, and adult obstructive sleep apnea.
Stanford is regarded as the leading institution in researching and treating obstructive sleep apnea. Research coming out of Stanford and from others has shown that there is a significant improvement in the pediatric airway following rapid palatal expansion. Dr. Giumillo states the best prevention for adult obstructive sleep apnea is to treat the child, thus decreasing the risk of obstructive sleep apnea as an adult.
Research recently completed by Dr. Way has shown a 47.5% increase in total posterior airway volume, a 42.3% increase in transverse dimension of the posterior airway behind the tongue, and a 21% increase behind the nose. The most constricted area of the posterior airway showed an increase of 76.7% in this study. There was also a similar increase in the minimal cross sectional area (the smallest or most constricted portion of the airway tube). This was a controlled study, with a sample of 141 patients pre and post rapid palatal expansion. There are many institutions documenting the improvement in airways with rapid palatal expansion at this time.
Dr. Way works closely with pulmonologists (sleep doctors) and ENT’s when pediatric obstructive sleep apnea is diagnosed. Below are examples of airway changes seen in the pediatric airway before and following rapid palatal expansion.
The other advantage of rapid palatal expansion is coordination of the transverse widths of the upper and lower jaws. This allows the “bite” to be corrected side to side as well as front to back while placing the roots in the middle of the horseshoe shape of bone. This results in healthier gum and bone support for one's entire lifetime.
The best airways, the healthiest gum and bone support, as well as coordinating the best jaw joint position with the best dental fit results in the healthiest patients with the best long-term stability. We want beautiful smiles built on the very best foundation possible. Pretty smiles built on poor foundations are short lived.
Presentation of symptoms associated with sleep disordered breathing in children depends on age.
- Failure to thrive
- Excessive daytime sleepiness
- Poor school performance
Night time symptoms in children with obstructive sleep apnea may include:
- Apnea (cessation of breathing)
- Hypopnea (decrease in airflow - rapid shallow breathing)
- Obstructive Ventilation (periods of hypercarbia without events as apnea and hypopnea)
- Frequent awakenings or restlessnesss
- Frequent nightmares
- Enuresis (bedwetting)
- Excessive daytime sleepiness/difficulty getting up in the morning
- Hyperactivity and/or behavior problems
- Daytime mouth breathing