Friday, June 26, 2015

Children with autism have higher cortisol levels

According to a recent study, children with autism were found to have elevated cortisol levels.

Researchers at the Institute for Autism Research at Canisius College have found that functional level appears to play a critical role in the stress levels of children with autism spectrum disorder (ASD). Specifically, lower-functioning children with ASD (LFASD) exhibited significantly higher levels of cortisol, the primary stress hormone in humans, than both high-functioning children with ASD (HFASD) and typical children.
Prior research has suggested that individuals with ASD experience elevated stress and related problems such as anxiety, however, many of the studies relied on informant rating scales and behavioral observations which have significant limitations for children with ASD. Attempts to more directly measure stress in this population using physiological measures such as cortisol have yielded mixed results. According to Susan K. Putnam PhD, chair and professor of psychology, the study's lead author, some of the inconsistent results may have been due to the prior studies not taking into account the significant differences in functional levels of individuals with ASD. "The inclusion of functionally-different individuals with ASD in studies has led to a need for studies of more precisely-defined subgroups with ASD, including subgroups based on functional level," said Putnam. This was the first study to assess cortisol (stress) levels in groups that were clearly differentiated based on functional level, specifically cognitive level.
Given the limitations in existing studies, the research team attempted to examine stress levels in ASD by examining the pattern of salivary cortisol across the day (morning, midday, and evening) and potential differences between lower-functioning children with ASD (LFASD IQ below 70), high-functioning children with ASD (HFASD IQ 85 or higher), and typical children. "It was important to determine whether the ASD groups exhibited the typical diurnal pattern of high cortisol in the morning, followed by a decrease at midday, and a further decline in the evening to determine if this typical pattern was present, and then examine the effect of functional level on stress level," said IAR co-director, Marcus Thomeer PhD, one of the study authors. Saliva samples were collected three times per day over four days on weekends from 13 children with LFASD, 16 children with HFASD, and 14 typical children. Results indicated that all three groups showed the typical pattern in which cortisol levels were highest at waking, followed by midday, and were lowest at bedtime. These findings are consistent with several prior studies of individuals with ASD.
The most significant finding, however, was that cortisol levels differed between the groups across the day. "Children with LFASD had significantly higher cortisol, the stress indicator, across the day than both the HFASD and typical children and, interestingly, children with HFASD did not significantly differ from the typical children across the day," said Putnam.
These findings have significant implications as they suggest that differences in cortisol levels and stress may be linked to the functional level, specifically IQ, of children with ASD. According to Putnam, this is an area in need of further study as it is unknown whether the elevated cortisol in the children with LFASD (compared to HFASD) is indicative of more significant neurological impairment and/or greater sensitivity to environmental stressors (associated with ASD symptoms), or whether a bi-directional relationship exists. IAR co-director Christopher Lopata PsyD, one of the study authors, noted that "identifying stress-level differences between functionally-differentiated groups with ASD has critical implications for how we assess and treat stress and stress-related reactions and conditions in children with ASD."
Findings from the study were recently published online first in the Journal of Developmental and Physical Disabilities.
Read more here

Attention issues may be helped by music therapy

Children with ADD, ADHD, and attention issues might be able to be helped by music therapy.
Focus can be a real struggle for people with learning disabilities like ADHD and ADD, but music is being found to be a powerful tool to train minds.
Middle school student Thomas Beckman has the developmental disability Down syndrome and uses music to help him focus.
He takes adapted music lessons at Rhythm & Rehab in Durham, where he gets to play his favorite instrument -- the drums -- as a form of neurologic music therapy.
"Music therapy is using music to accomplish non-musical goals," said Paula Scicluna, the founder and executive director of Rhythm & Rehab. "So, using music to improve speech skills, language, sensory motor skills, cognitive skills, social emotional skills."
At the beginning of his lesson, Thomas banged the drums loudly, looked around at his surroundings and was not focused. He was very distracted.
Encouraging him to keep in time, Scicluna patted the drums saying, "Together, together, together. Can you do it together?"
Thomas ignored instruction.
However, as the session progressed -- in a matter of minutes -- something clicked and his focus increased.
He and Scicluna then moved to the keyboard, and as they attempted to play a duet, he was more in tune to the rhythm and "making music." He intently glanced up at his song sheet and glanced down making sure he hit each key precisely.
"I don't expect him to leave here playing Chopin," said Donna Beckmann, Thomas' mother.
She said the benefits of playing music, such as hand-eye coordination, helps him in his everyday life.
"Whether he's writing something, whether he's helping in the kitchen and cutting up vegetables, it's all connected, she said.
Scicluna pointed out that the quality of Thomas' playing is not what matters, but rather he "continued to play and that he stayed with the activity until I told him to stop."
She said music helps organize the brain, and repetition is key.
"Once you add that rhythm and you add that structure, it helps actually organize the firing of the neurons. Focus, attention [and] impulse control -- all those behaviors that you see children with ADHD and ADD struggle with," Scicluna said. "That's how music therapy is helpful to those children."
So, while some may view Thomas' drumming as noise, he hears music.
"He gets a lot of feedback from heavy movements. So for him to be banging on the drums, that does something for him," his mother said. "The type of focus that this trains him in is to focus when he needs to. The therapy gives him tools to reach his goals."
Beckmann said the structure grounds him, and his instructors have high expectations.
"They know the potential. They know what these individuals are able to do, and they don't settle for less," she said. "That's why you see the phenomenal things my son can do."
Thomas was so focused, he continued to play the keyboard.
"To see him so focused and visually tracking and using the right fingers on the right keys," Scicluna said. "For those of us that don't have to really think about all of those skills independently, you think of all those skills that have to come together in order for that to happen, it's incredible."
Beckmann said, "It's working on so many different pieces of what he needs. I see a more whole child because of music therapy. It's music, it's fun."
Read more here

Adults need 7 hours of sleep each night

A study claims that adults need 7 hours of sleep each night.

Seven hours of shut-eye: That's the minimum amount of sleep that adults need each night for best health, according to new recommendations from a panel led by a University of Washington sleep expert.
And functioning effectively - without guzzling gallons of coffee - could require even more sleep, said Dr. Nathaniel F. Watson, a professor of neurology and co-director of the UW Medicine Sleep Center.
"Seven hours - that's the lower limit of the threshold," said Watson. "We don't want people walking away thinking, 'I need only seven hours of sleep a night.'"

In fact, the 15-member panel declined to put an upper limit on ideal sleep for adults ages 18 to 60 after spending a year reviewing more than 5,300 scientific articles about the link between sleep and optimal health. The results were published in the journal Sleep.
"This is a general recommendation for what it takes to remain alert and productive without stimulants," Watson said, adding that the advice applies to those older than 60, as well.
Sleeping nine hours or more a night might be appropriate for young adults, people recovering from sleep deficits and those who are ill. It's not clear whether sleeping so long is ideal for everyone else - but it's almost certainly better than sleeping too little, the researchers agreed.
Getting that message across may be difficult in the U.S., where about one-third of people ages 18 and older say they sleep six hours or less a night, according to a new federal study.
Sleep deprivation is sometimes seen as a badge of the busy or a marker of determination, Watson said.
"It's the zeitgeist of our times," he said. "We're trying to get at this notion that if you're Type A, you don't sleep. How do we change that?"
In fact, sleeping less than seven hours a night is associated with all kinds of health problems: weight gain and obesity, diabetes, high blood pressure, heart disease, depression - and a higher risk of early death, the researchers found. It is also linked to decreased immune-system function, greater pain sensitivity, problems performing at work or other activities, increased errors and a higher risk of accidents, the group noted.
To determine how much sleep is enough, Watson recommended that people conduct a three-week experiment.
"Go to bed when you're tired; wake up spontaneously when you feel rested," he said. "Then assess how you feel during the day, how you perform during the day."
At least seven hours of snooze time will likely boost both measures, he predicted. While caffeine and other stimulants temporarily mask the effects of fatigue, they do nothing to prevent the toll on health.
"It's really important for people to understand there's no substitute for sleep," Watson said.
Read more here

Signs and treatments for obstructive sleep apnea in children

Obstructive sleep apnea in children may be missed due to misdiagnosis of symptoms such as hyperactivity, tossing and turning, and irregular breathing at night.

Is your hyperactive child having trouble learning at school? Does your son constantly toss and turn at night? Can you hear your daughter's irregular breathing during sleep?
All of these symptoms could be the result of obstructive sleep apnea, a serious but treatable disorder that can lead to health problems, behavioral issues and learning difficulties in children and adolescents.
"One to 4 percent of all children have obstructive sleep apnea, but many go undiagnosed and untreated because people do not recognize the symptoms," says Dr. Rochelle Goldberg, director of sleep medicine services at Main Line Health and an associate professor at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.
Further complicating matters is that some children with sleep apnea are misdiagnosed with attention deficit hyperactivity disorder because, unlike adults, disrupted sleep makes kids hyperactive, experts say.
"As many as 25 percent of children diagnosed with ADHD may in fact have obstructive sleep apnea," says Tracy Nasca, executive director of the American Sleep Apnea Association, a nonprofit organization based in the District of Columbia.
Blocked Airways Impede Breathing
Sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. People with untreated sleep apnea stop breathing repeatedly during sleep, often waking or almost waking multiple times during the night.
"The result is fragmented sleep that can impact every aspect of your life," Goldberg says.
Sleep apnea can occur at any age, but the prime ages for children to develop the condition is between 4 to 7 years, when the tonsils and adenoids are largest, Goldberg says. Those most at risk include males, children with special needs and youth who are obese.
"With increasing childhood obesity comes increasing risk for sleep apnea," Goldberg says, noting thatobesity among youth has skyrocketed in the past three decades. Obesity rates in children ages 6 to 11 increased from 7 to 18 percent from 1980 to 2012, while the rate in youth ages 12 to 19 jumped from 5 to 21 percent, according to the Centers for Disease Control and Prevention.
Hyperactivity in Sleepy Children
Diagnosing sleep disorders in children requires special expertise because youngsters respond differently than adults when it comes to a lack of sleep, says Amber McAfee, a pediatric nurse practitioner at the Sleep Center at Seattle Children's Hospital.
"Adults with sleep apnea may feel sluggish during the day," McAfee says. "But children with sleep apnea are quite active and may even be hyperactive. They may also start experiencing learning difficulties at school because they can't remember things as well."
Adds Goldberg: "Unfortunately some of these kids get mislabeled by their well-meaning teachers as having ADHD and start taking medications they don't need." She advises parents to seek the expertise of a pediatrician and pediatric sleep specialist before assuming their child has ADHD.
In recent years, more parents have been requesting sleep evaluations for children diagnosed with ADHD, McAfee says. "We have seen an improvement in hyperactivity after treatment and we have parents who report taking their children off medication for ADHD because their hyperactivity was related to sleep apnea," she says.
Nighttime symptoms between children and adults vary, too. Kids are more likely to be restless and wake up. "The symptoms are a little more subtle in kids because their brains are responsive," McAfee says. "The brain alerts them that they aren't breathing well."
Some children may sleep with their head hanging from the end of the bed as a way to extend their neck and open their air pathway, Goldberg says. At times, children with sleep apnea may experience increased bedwetting or a recurrence of bedwetting.
Expert Diagnosis and Treatment
Experts recommend that parents whose children are experiencing sleep problems or sudden difficulties at school visit a certified pediatric sleep specialist for evaluation and testing, including an overnight sleep study, to rule out or confirm a diagnosis.
"We do a lot of hand holding and comforting," says Nasca, who assures parents that pediatric specialists can provide a child-friendly diagnostic experience. "Many pediatric sleep labs allow a parent to spend the night in the testing room and also encourage the children to bring a favorite 'blankie' or stuffed animal to create a more home-like sleep setting."
At Seattle Children's Hospital, parents are welcome to stay at the Sleep Center while their children are monitored overnight. Monitors gather information about brain activity, oxygen levels, heart rate, sleep quality and stages, eye movement, air flow, limb movement and more.
"I tell kids they're going to sleep like a robot for one night," McAfee says. The Sleep Clinic conducts approximately 200 sleep studies a month.
For many youngsters, surgically removing the tonsil and adenoids can resolve sleep apnea. Children who are overweight or obese may also need to focus on weight loss, experts say.
Some children find relief by wearing a nasal mask that uses continuous positive airway pressure, also known as CPAP. "CPAP is 100 percent effective in improving your breathing," McAfee says. "But only about 40 percent of the pediatric population wear the mask effectively through the night."
Read more here

Brain interactions may cause people with autism to be hypersensitive

Research indicates a scientific reason involving brain interactions for people and children with autism to be hypersensitive. This provides a potential avenue for treating hypersensitivity

The increased interaction between cortical and subcortical brain regions highlights the central role of hypersensitivity and other sensory symptoms in defining Autism Spectrum Disorder (ASD). This is presented in research performed by a team led by Christian Keysers and Leonardo Cerliani at the Netherlands Institute for Neuroscience in Amsterdam. This finding provides a key to understand the often underestimated sensory hypersensitivity in autism and to seed a scientific understanding of how to tackle this hypersensitivity. The research was published in JAMA Psychiatry on June 10.
People with ASD are known for their unusual behavior in the social environment. Moreover, they often report other traits, linked to the sensory environment: for instance the ability to perceive small details in a picture or to detect a very soft sound coming from a distance. "This hypersensitivity, however, is not always a gift: being captured by the myriad of sensory stimuli we continuously receive from the environment can be distracting and even overwhelming, and prevents us to focus on what we care most," says Cerliani. The scientists present in their research that increased interaction between the cortical ad subcortical brain regions is at the root of this hypersensitivity.
Brain activity
Brain regions that are strongly coupled have brain activity that goes up and down together, even while relaxing, while regions that are not coupled will have their brain activity fluctuate independently from each other. By comparing how this spontaneous brain activity synchronizes across various brain regions the team identified an abnormally high synchrony between the sensory cortices involved in perception and subcortical regions relaying information from the sensory organs to the cortex. They found that a higher synchrony was associated with a higher severity of autistic traits.
"During the development from childhood to adolescence, the spontaneous activity of cortical regions involved in basic sensory perception decouples from the activity of subcortical structures relaying sensory information from the sensory organs to the cortex," explains Keysers. "This decoupling is thought to reflect the increasing ability to block out irrelevant sensory information from perception, allowing people to focus on their stream of thoughts and actions. In ASD this process appears to be altered: their sensory cortex appears to be abnormally coupled to subcortical structures."
Large database
The team made these observations using resting-state functional magnetic resonance imaging (fMRI) data from the largest neuroimaging database on ASD aggregated so far: the ABIDE, founded and coordinated by Dr. Adriana Di Martino, Dr. Stuart Mostofsky and Dr. Michael Milham. The team of Keysers and Cerliani also contributed to the aggregation of this database with the neuroimaging data acquired by Dr. Marc Thioux.
Autism Spectrum Disorder
ASD is an umbrella name for a number of developmental disorders, including classic autism and Asperger syndrome. The number of people with ASD is almost eightfold in the last twenty years and is seen in more than 1% of the children.
Read more here

Sunday, June 21, 2015

Study: Positive Genetic Testing Increases Maternal Quality of Life

Obtaining a Genetic Diagnosis in a Child with Disability: Impact on Parental Quality of Life


  • Developmental delay;
  • intellectual disability;
  • array-based comparative genomic hybridization;
  • chromosomal microaberration;
  • quality of life


Recent progress in genetic testing has facilitated obtaining an etiologic diagnosis in children with developmental delay/intellectual disability (DD/ID) or multiple congenital anomalies (MCA) or both. Little is known about the benefits of diagnostic elucidation for affected families. We studied the impact of a genetic diagnosis on parental quality of life (QoL) using a validated semiquantitative questionnaire in families with a disabled child investigated by array CGH. We received completed questionnaires from 95 mothers and 76 fathers of 99 families. We used multivariate analysis for adjustment of potential confounders. Taken all 99 families together maternal QoL score (percentile rank scale 51.05) was significantly lower than fathers' QoL (61.83, p = 0.01). Maternal QoL score was 20.17 (95% CI [5.49; 34.82]) percentile rank scales higher in mothers of children with diagnostic (n = 34) array CGH as opposed to mothers of children with inconclusive (n = 65) array CGH (Hedges' g 0,71). Comparison of these QoL scores with retrospectively recalled QoL before array CGH revealed an increase of maternal QoL after diagnostic clarification. Our results indicate a benefit for maternal QoL if a genetic test, here array CGH, succeeds to clarify the etiologic diagnosis in a disabled child.

Friday, June 19, 2015

Cannabidiol and Pediatric Epilepsy: What is the Evidence?

 2013 Dec;29(3):574-7. doi: 10.1016/j.yebeh.2013.08.037.

Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy.


Severe childhood epilepsies are characterized by frequent seizures, neurodevelopmental delays, and impaired quality of life. In these treatment-resistant epilepsies, families often seek alternative treatments. This survey explored the use of cannabidiol-enriched cannabis in children with treatment-resistant epilepsy. The survey was presented to parents belonging to a Facebook group dedicated to sharing information about the use of cannabidiol-enriched cannabis to treat their child's seizures. Nineteen responses met the following inclusion criteria for the study: a diagnosis of epilepsy and current use ofcannabidiol-enriched cannabis. Thirteen children had Dravet syndrome, four had Doose syndrome, and one each had Lennox-Gastaut syndrome and idiopathic epilepsy. The average number of antiepileptic drugs (AEDs) tried before using cannabidiol-enriched cannabis was 12. Sixteen (84%) of the 19 parents reported a reduction in their child's seizure frequency while taking cannabidiol-enriched cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue. Our survey shows that parents are using cannabidiol-enriched cannabis as a treatment for their children with treatment-resistant epilepsy. Because of the increasing number of states that allow access to medical cannabis, its use will likely be a growing concern for the epilepsy community. Safety and tolerability data for cannabidiol-enriched cannabis use among children are not available. Objective measurements of a standardized preparation of pure cannabidiol are needed to determine whether it is safe, well tolerated, and efficacious at controlling seizures in this pediatric population with difficult-to-treat seizures.
© 2013.


Cannabidiol; Dravet syndrome; Epilepsy; Intractable; Medically refractory seizures; Pediatric; Side effects; Treatment-resistant

Biologic Plausibility

Cannabidiol Displays Antiepileptiform and Antiseizure Properties In Vitro and In VivoS⃞

Can Braces Cure Sleep Apnea? What is the evidence?

What is the evidence? Orthodontic Treatment of PEDIATRIC  Sleep Apnea with Rapid Maxillary Expansion 

Probably yes. - JR

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 2011 May;15(2):179-84. doi: 10.1007/s11325-011-0505-1. Epub 2011 Mar 25.

Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up.



In view of the positive outcome of orthodontic treatment using rapid maxillary expansion (RME) on sleep-disordered breathing, we generated data on RME in children with obstructive sleep apnea (OSA) by evaluating objective and subjective data over a 36-month follow-up period, to determine whether RME is effective in the long-term treatment of OSA. We selected all patients with dental malocclusions and OSA syndrome (OSAS) confirmed by polysomnography.


Ten of the 14 children who completed the 12-month therapeutic trial using RME were enrolled in our follow-up study. The study was performed 24 months after the end of the RME orthodontic treatment. We enrolled all children presented with deep, retrusive or crossbite at the orthodontic evaluation. All subjects underwent an overnight polysomnography at the baseline, after 1 year of treatment and 24 months after the end of the orthodontic treatment. The children's mean age was 6.6 ± 2.1 years at entry and 9.7 ± 1.6 years at the end of follow-up.


After treatment, the apnea hypopnoea index (AHI) decreased and the clinical symptoms had resolved by the end of the treatment period. Twenty-four months after the end of the treatment, no significant changes in the AHI or in other variables were observed.


RME may be a useful approach in children with malocclusion and OSAS, as the effects of such treatment were found to persist 24 months after the end of treatment.
[PubMed - indexed for MEDLINE]
Icon for Springer
 2011 May;15(2):173-7. doi: 10.1007/s11325-010-0419-3. Epub 2010 Sep 17.

Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study.



When both narrow maxilla and moderately enlarged tonsils are present in children with obstructive sleep apnea, the decision of which treatment to do first is unclear. A preliminary randomized study was done to perform a power analysis and determine the number of subjects necessary to have an appropriate response. Thirty-one children, 14 boys, diagnosed with OSA based on clinical symptoms and polysomnography (PSG) findings had presence of both narrow maxillary complex and enlarged tonsils. They were scheduled to have both adeno-tonsillectomy and RME for which the order of treatment was randomized: group 1 received surgery followed by orthodontics, while group 2 received orthodontics followed by surgery. Each child was seen by an ENT, an orthodontist, and a sleep medicine specialist. The validated pediatric sleep questionnaire and PSG were done at entry and after each treatment phase at time of PSG. Statistical analyses were ANOVA repeated measures and t tests.


The mean age of the children at entry was 6.5 ± 0.2 years (mean ± SEM). Overall, even if children presented improvement of both clinical symptoms and PSG findings, none of the children presented normal results after treatment 1, at the exception of one case. There was no significant difference in the amount of improvement noted independently of the first treatment approach. Thirty children underwent treatment 2, with an overall significant improvement shown for PSG findings compared to baseline and compared to treatment 1, without any group differences.


This preliminary study emphasizes the need to have more than subjective clinical scales for determination of sequence of treatments.
[PubMed - indexed for MEDLINE]
Icon for Springer
 2009 Apr;10(4):471-8. doi: 10.1016/j.sleep.2008.04.003. Epub 2008 Aug 26.

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



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).


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.


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.


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.
[PubMed - indexed for MEDLINE]
Icon for Elsevier Science
 2008 Jul;31(7):953-7.

Orthodontic expansion treatment and adenotonsillectomy in the treatment of obstructive sleep apnea in prepubertal children.

Erratum in

  • Sleep. 2009 Jan 1;32(1):table of contents.



Rapid maxillary expansion and adenotonsillectomy are proven treatments of obstructive sleep apnea (OSA) in children. Our goal was to investigate whether rapid maxillary expansion should be offered as an alternative to surgery in select patients. In addition, if both therapies are required, the order in which to perform these interventions needs to be determined.


Prepubertal children with moderate OSA clinically judged to require both adenotonsillectomy and orthodontic treatment were randomized into 2 treatment groups. Group 1 underwent adenotonsillectomy followed by orthodontic expansion. Group 2 underwent therapies in the reverse sequence.


Thirty-two children (16 girls) in an academic sleep clinic.


Clinical evaluation and polysomnography were performed after each stage to assess efficacy of each treatment modality.


The 2 groups were similar in age, symptoms, apnea-hypopnea index, and lowest oxygen saturation. Two children with orthodontic treatment first did not require subsequent adenotonsillectomy. Thirty children underwent both treatments. Two of them were still symptomatic and presented with abnormal polysomogram results following both therapies. In the remaining 28 children, all results were significantly different from those at entry (P = 0.001) and from single therapy (P = 0.01), regardless of the order of treatment. Both therapies were necessary to obtain complete resolution of OSA.


In our study, 87.5% of the children with sleep-disordered breathing had both treatments. In terms of treatment order, 2 of 16 children underwent orthodontic treatment alone, whereas no children underwent surgery alone to resolve OSA. Two children who underwent both treatments continued to have OSA.
[PubMed - indexed for MEDLINE] 
Free PMC Article
Icon for PubMed Central
 2008 Dec;122(12):1318-24. doi: 10.1017/S002221510800279X. Epub 2008 Jun 25.

Down syndrome: otolaryngological effects of rapid maxillary expansion.



Phenotypical Down syndrome includes pharyngeal and maxillary hypoplasia and, frequently, constricted maxillary arch with nasal obstruction.


This clinical trial assessed the effects of rapid maxillary expansion on ENT disorders in 24 children with Down syndrome randomly allocated to receive either rapid maxillary expansion or not. Each group received ENT and speech therapy assessments before expansion and after the device had been removed.


In the rapid maxillary expansion group, the yearly ENT infection rate was reduced when assessed after device removal (p < 0.01). The parents of rapid maxillary expansion children reported a reduction in respiratory obstruction symptoms. Audiological assessment revealed improvements in the rapid maxillary expansion group (p < 0.01). Cephalometry showed increased maxillary width in the rapid maxillary expansion group.


Rapid maxillary expansion resulted in a reduction in hearing loss, yearly rate of ENT infections and parentally assessed symptoms of upper airway obstruction, compared with no treatment. These findings are probably related to expanded oronasal space, due to rapid maxillary expansion.
[PubMed - indexed for MEDLINE]
Icon for Cambridge University Press
 1998 Dec 15;21(8):831-5.

Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion.


The precise role of maxillary constriction in the pathophysiology of obstructive sleep apnea (OSA) is unclear. However, it is known that subjects with maxillary constriction have increased nasal resistance and resultant mouth-breathing, features typically seen in OSA patients. Maxillary constriction is also associated with alterations in tongue posture which could result in retroglossal airway narrowing, another feature of OSA. Rapid maxillary expansion (RME) is an orthodontic treatment for maxillary constriction which increases the width of the maxilla and reduces nasal resistance. The aim of this pilot study was to investigate the effect of rapid maxillary expansion in OSA. We studied 10 young adults (8 male, 2 female, mean age 27 +/- 2 [sem] years) with mild to moderate OSA (apnea/hypopnea index-AHI 19 +/- 4 and minimum SaO2 89 +/- 1%), and evidence of maxillary constriction on orthodontic evaluation. All patients underwent treatment with RME, six cases requiring elective surgical assistance. Polysomnography was repeated at the completion of treatment. Nine of the 10 patients reported improvements in snoring and hypersomnolence. There was a significant reduction in AHI (19 +/- 4 vs 7 +/- 4, p < 0.05) in the entire group. In seven patients, the AHI returned to normal (i.e., = < 5); only one patient showed no improvement. These preliminary data suggest that RME may be a useful treatment alternative for selected patients with OSA.
[PubMed - indexed for MEDLINE]