NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome

Miano, Silvia; Rizzoli, Alessandra; Evangelisti, Melania; Bruni, Oliviero; Ferri, Raffaele; Pagani, Jacopo; Villa, Maria Pia

doi:10.1016/j.sleep.2008.04.003

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Volume 10, Issue 4 , Pages 471-478, April 2009

NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome

Silvia Miano
- Department of Pediatric, Sleep Disease Centre, University of Rome La Sapienza-Sant’Andrea Hospital, Via Grottarossa 1035/1039, Rome 00189, Italy
Alessandra Rizzoli
- Department of Pediatric, Sleep Disease Centre, University of Rome La Sapienza-Sant’Andrea Hospital, Via Grottarossa 1035/1039, Rome 00189, Italy
Melania Evangelisti
- Department of Pediatric, Sleep Disease Centre, University of Rome La Sapienza-Sant’Andrea Hospital, Via Grottarossa 1035/1039, Rome 00189, Italy
Oliviero Bruni
- Department of Developmental Neurology and Psychiatry, Centre for Pediatric Sleep Disorders, University of Rome La Sapienza, Rome, Italy
Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
Jacopo Pagani
- Department of Pediatric, Sleep Disease Centre, University of Rome La Sapienza-Sant’Andrea Hospital, Via Grottarossa 1035/1039, Rome 00189, Italy
Maria Pia Villa
- Department of Pediatric, Sleep Disease Centre, University of Rome La Sapienza-Sant’Andrea Hospital, Via Grottarossa 1035/1039, Rome 00189, Italy
- Corresponding author. Tel.: +39 0633775855; fax: +39 0633775941.

Received 27 February 2008; received in revised form 29 April 2008; accepted 30 April 2008.

Abstract

Objective

To evaluate NREM sleep microstructure in children with obstructive sleep apnea syndrome (OSAS) before and after one year of rapid maxillary expander (RME) treatment by means of the cyclic alternating pattern (CAP).

Methods

Nine children with OSAS aged 4–8 years (6 males, mean age 6.4±1.97 years) and age-matched normal controls were included. All subjects underwent an overnight polysomnography in the sleep laboratory after one adaptation night, as a baseline evaluation; children with OSAS were recorded again after one year of RME treatment.

Results

After one year of treatment the OSAS group showed a longer duration of time in bed and sleep period time, a reduction in number of stage shifts compared to baseline recordings, and the apnea–hypopnea index decreased significantly. At baseline, the OSAS group had a higher CAP rate during slow-wave sleep and an increased A2 index compared to normal controls. After one year of RME application, children with OSAS showed an increase in CAP rate associated with an increase of A1 index during slow-wave sleep.

Conclusions

RME treatment almost normalized sleep architecture and improved sleep respiratory disturbances; however, sleep microstructure and respiratory parameters did not completely recover. The persistence of increased CAP rate in slow-wave sleep associated with an increase of A1 index might reflect a partial failure of orthodontic treatment. On the other hand, the rebound of A1 subtypes might be an indirect sign of an attempt to normalize sleep that has been disturbed by the respiratory events.

Keywords: Obstructive sleep apnea, Children, Rapid maxillary expander, Cyclic alternating pattern, NREM sleep instability, Arousal