Case Report  |   February 2019
Rapid Maxillary Expansion and Adenotonsillectomy in 9-Year-Old Twins With Pediatric Obstructive Sleep Apnea Syndrome: An Interdisciplinary Effort
Author Notes
  • From the Department of Pediatrics at Greenville ENT in South Carolina (Dr Alexander); Palmetto Pulmonology Associates in Greenville, South Carolina (Dr Boota); MedBridge Home Medical in Greenville, South Carolina (Mr Hooks); and the Greenville Sleep and Breathing Specialists, LLC, in South Carolina (Dr White).  
  • Financial Disclosures: None reported.  
  • Support: None reported.  
  •  *Address correspondence to John R. White, DDS, Greenville Sleep and Breathing Specialists, LLC, 7 Seabrook Ct, Greenville, SC 29607-3625. Email: jrwgville2@gmail.com
     
Article Information
Case Report   |   February 2019
Rapid Maxillary Expansion and Adenotonsillectomy in 9-Year-Old Twins With Pediatric Obstructive Sleep Apnea Syndrome: An Interdisciplinary Effort
The Journal of the American Osteopathic Association, February 2019, Vol. 119, 126-134. doi:10.7556/jaoa.2019.019
The Journal of the American Osteopathic Association, February 2019, Vol. 119, 126-134. doi:10.7556/jaoa.2019.019
Abstract

Pediatric obstructive sleep apnea is known to cause neurocognitive problems, yet it often goes undetected or mistreated. The authors describe 9-year-old twins with snoring, enlarged tonsils, and excessive daytime sleepiness whose symptoms had been previously disregarded by health care professionals. At presentation, a dentist found the patients to be midface deficient and symptomatic. A home sleep test, prescribed by the dentist, revealed apnea-hypopnea index readings of 74/h and 16/h, respectively. The children were referred to an otolaryngologist, and a continuous positive airway pressure therapy trial resulted in improved cognition and temperament. Rapid maxillary expansion was then performed at the dentist office, followed by adenotonsillectomy by an ear, nose, and throat specialist and myofunctional rehabilitation with a speech pathologist for both patients. After treatment, results mimicked those reported during the continuous positive airway pressure trial, with substantially reduced apnea-hypopnea index of 0.9/h and 1.6/h. This case highlights the interdisciplinary nature of pediatric obstructive sleep apnea management and the need for all health care professionals to receive comprehensive sleep medicine training for proper diagnosis and treatment.

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