Bariani Rita Catia Brás, Bigliazzi Renato, Costa Emília Leite de Barros, Tufik Sergio, Fujita Reginaldo Raimundo, Moreira Gustavo Antonio
Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Private Practive in Orthodontics, São Paulo, SP, Brazil.
Int J Pediatr Otorhinolaryngol. 2023 May;168:111548. doi: 10.1016/j.ijporl.2023.111548. Epub 2023 Apr 7.
To assess the short-term outcome of rapid maxillary expansion (RME) on periodic limb movement disorder (PLMD) in children with residual snoring after late adenotonsillectomy (AT).
This prospective clinical trial included 24 patients treated with rapid maxillary expansion (RME). Participants' inclusion criteria were children with maxillary constriction aged 5-12 years who had AT for more than two years and those whose parents/guardians reported that they still snored ≥4 nights per week. Of which 13 had primary snoring, and 11 had OSA. All patients underwent laryngeal nasofibroscopy evaluation and complete polysomnography. The Quality of life (QOL) Questionnaire (OSA-18), the Pediatric Sleep Questionnaire (PSQ), the Conners Abbreviated Scale (CAE), and the Epworth Sleep Scale (ESS) were applied before and after palatal expansion.
The OSA 18 domain, PSQ total, CAE, and ESS scores were significantly reduced in both groups (p < 0.001). There was a decrease in PLMS indices. In the total sample, the mean decreased significantly from 4.15 to 1.08. In the Primary Snoring group, the mean decreased from 2.64 to 0.99; in the OSA group, the average decreased significantly from 5.95 to 1.19.
This preliminary study suggests that the improvement of PLMS in the OSA group with maxillary constriction is correlated with a favorable neurological impact of the treatment. We suggest a multi-professional approach to the treatment of sleep disorders in children.
评估快速上颌扩弓（RME）对晚期腺样体扁桃体切除术（AT）后仍有打鼾症状的儿童周期性肢体运动障碍（PLMD）的短期疗效。
这项前瞻性临床试验纳入了24例接受快速上颌扩弓治疗的患者。参与者的纳入标准为5至12岁的上颌狭窄儿童，这些儿童已接受腺样体扁桃体切除术两年以上，且其父母/监护人报告他们每周仍打鼾≥4晚。其中13例为原发性打鼾，11例为阻塞性睡眠呼吸暂停（OSA）。所有患者均接受了喉鼻纤维镜检查评估和完整的多导睡眠图检查。在腭部扩弓前后应用生活质量（QOL）问卷（OSA-18）、儿童睡眠问卷（PSQ）、康纳斯简明量表（CAE）和爱泼华嗜睡量表（ESS）。
两组的OSA 18领域、PSQ总分、CAE和ESS评分均显著降低（p < 0.001）。周期性肢体运动（PLMS）指数有所下降。在总样本中，平均值从4.15显著降至1.08。在原发性打鼾组中，平均值从2.64降至0.99；在OSA组中，平均值从5.95显著降至1.19。
这项初步研究表明，上颌狭窄的OSA组中PLMS的改善与治疗对神经的有益影响相关。我们建议采用多专业方法治疗儿童睡眠障碍。
