Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross-over randomized controlled trial.

Objective: To determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea-hypopnea index (AHI) and minimum oxygen saturation (MinSaO ₂ ) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship.
Study Design/methods: Thirty-two nonobese children with balanced maxillomandibular relationship and a mean age of 8.8 years, with a graded III/IV tonsillar hypertrophy and maxillary constriction, participated in a cross-over randomized controlled trial. As the first intervention, one group underwent AT while the other underwent RPE. After 6 months, interventions were switched in those groups, but only to participants with an AHI > 1 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T ₀ ), 6 months after the first (T ₁ ) and the second (T ₂ ) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO ₂ severity, and intervention sequence were evaluated using linear regression analysis. Intra- and intergroup comparisons for AHI and MinSaO ₂ were performed using ANOVA and Tukey's test.
Results: The initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO ₂ severity accounted for 83.1% of MinSaO ₂ improvement changes. Most AHI reductions and MinSaO ₂ improvements were due to AT.
Conclusions: Initial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO ₂ severity alone accounted for the most changes in MinSaO ₂ increase. In most cases, RPE had a marginal effect on AHI and MinSaO ₂ when adjusted for confounders.
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