Aksilp Chalermthai, Pechpongsai Pattaralapa, Intakorn Pavinee, Chaweewannakorn Chaiyapol, Boonpratham Supatchai, Satravaha Yodhathai, Anuwongnukroh Niwat, Peanchitlertkajorn Supakit
Division of Respiratory and Critical Care Medicine, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
Sleep Breath. 2025 Jul 30;29(4):256. doi: 10.1007/s11325-025-03427-8.
Adenotonsillectomy (AT) is usually recommended as the first-line therapy for pediatric obstructive sleep apnea (POSA). While AT treats soft tissue obstruction, it does not address the underlying skeletal abnormalities, such as maxillary constriction. Despite growing evidence supporting RME as a treatment option for POSA, a significant research gap remains. Therefore, we conducted a randomized controlled trial to compare treatment efficacy between RME and AT.
This study recruited 24 children diagnosed with POSA and presented with concurrent significant adenotonsillar hypertrophy and transverse maxillary deficiency. Participants were randomly assigned to either AT or RME for treatment. All participants underwent Type I PSG at baseline and 6 months post-treatment. Additional assessments included dental and cephalometric analyses, the pediatric sleep questionnaire (PSQ), and the OSA-18 questionnaire. Baseline and endpoint comparisons between the two treatment groups were performed.
The median baseline AHI for the AT and RME groups was 7.0 (5.25-9.9) and 6.85 (5.6-8.05) events/hour, respectively. There was no significant difference between treatment groups in all parameters at baseline. The comparisons between pre- and post-treatment results showed significant improvements across multiple parameters, including AHI for both AT and RME. There was no significant difference in PSG parameters (AHI, LSAT, MSAT, and REM sleep time) and cure rate between RME and AT. The post-treatment AHI for the AT and RME groups was 1.4 (0.7-1.85) and 2.3 (1.15-5.7) events/hour, respectively. However, PSQ and OSA-18 scores were significantly higher for the RME group.
RME and AT significantly improved sleep-related respiratory parameters in patients with POSA. RME demonstrated comparable efficacy to AT in reducing AHI and improving LAST, MSAT, and REM sleep time. However, AT provided significantly better improvement in clinical symptoms and quality of life.
The registration of this randomized controlled trial was approved on August 24th, 2023, under the registration number TCTR20230824001.
腺样体扁桃体切除术（AT）通常被推荐为小儿阻塞性睡眠呼吸暂停（POSA）的一线治疗方法。虽然AT可治疗软组织阻塞，但它无法解决潜在的骨骼异常问题，如上颌狭窄。尽管越来越多的证据支持快速上颌扩弓（RME）作为POSA的一种治疗选择，但仍存在重大研究空白。因此，我们进行了一项随机对照试验，以比较RME和AT的治疗效果。
本研究招募了24名被诊断为POSA且同时伴有明显腺样体扁桃体肥大和上颌横向发育不足的儿童。参与者被随机分配接受AT或RME治疗。所有参与者在基线和治疗后6个月均接受了I型多导睡眠图（PSG）检查。额外的评估包括牙科和头影测量分析、儿童睡眠问卷（PSQ）以及OSA-18问卷。对两个治疗组的基线和终点进行了比较。
AT组和RME组的基线平均每小时呼吸暂停低通气指数（AHI）中位数分别为7.0（5.25 - 9.9）次/小时和6.85（5.6 - 8.05）次/小时。治疗组在基线时所有参数均无显著差异。治疗前后结果的比较显示，包括AT组和RME组的AHI在内的多个参数均有显著改善。RME组和AT组在PSG参数（AHI、最低血氧饱和度[LSAT]、平均血氧饱和度[MSAT]和快速眼动睡眠时间）及治愈率方面无显著差异。AT组和RME组治疗后的AHI分别为1.4（0.7 - 1.85）次/小时和2.3（1.15 - 5.7）次/小时。然而，RME组的PSQ和OSA-18评分显著更高。
RME和AT均显著改善了POSA患者与睡眠相关的呼吸参数。RME在降低AHI以及改善最低血氧饱和度、平均血氧饱和度和快速眼动睡眠时间方面显示出与AT相当的疗效。然而，AT在改善临床症状和生活质量方面效果显著更好。
这项随机对照试验的注册于2023年8月24日获得批准，注册号为TCTR20230824001。
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