Slow maxillary expansion as therapeutic alternative to obstructive sleep apnea in children with Down syndrome: case report

The sleep plays key role in human cognitive and weight development.Obstructive sleep apnea syndrome (OSAS) is featured by partial or total obstruction of upper airways during the sleep, associated with oxygen desaturation, fragmentation, and changes in restful sleep stages.It presents multifactorial etiology and concerns individual anatomical, functional and genetic aspects, as well as triggers important cardio-respiratory, cognitive and behavioral diseases.Trisomy 21 (Down syndrome) is featured by anatomical, neuromuscular and neurocognitive changes that lead to higher incidence of breathing disorders during the sleep.The aim of the present study is to report the dental intervention strategy, based on multidisciplinary planning applied to a 3-year-old male patient with T21, who presented restless and fragmented sleep, and apnea hypopnea index (AHI) of 7.2, with 19.6 awakenings per hour and minimum oxygen saturation of 86% overnight, in initial polysomnography requested by a neurologist.Conservative and customized orthodontic treatment based on maxillary disjunction with HAAS-type appliance, three times activation a week -performed by family members after guidance by the dental surgeon in charge -was recommended.A new polysomnography, which showed reduced AHI value (0.2 per hour of sleep) and minimum saturation of 92%, was carried out after 5 months of active orthodontic treatment combined to the follow-up by a speech therapist -this reduction has effectively helped improving the child's quality of sleep.The patient used dental appliance for 4 months without activations, and it allowed the bone remodeling phase.According to the present case report, the conservative orthodontic intervention through slow maxillary expansion, based on multidisciplinary practices and strategies, is an important treatment to improve the quality of sleep of children with Down syndrome and OSAS.