{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:36:44Z","timestamp":1790757404631,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea\u2010hypopnea index (AHI) and minimum oxygen saturation (MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      ) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design\/Methods<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010two 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\u2010over 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\u2009&gt;\u20091 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T\n                      <jats:sub>0<\/jats:sub>\n                      ), 6 months after the first (T\n                      <jats:sub>1<\/jats:sub>\n                      ) and the second (T\n                      <jats:sub>2<\/jats:sub>\n                      ) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      severity, and intervention sequence were evaluated using linear regression analysis. Intra\u2010 and intergroup comparisons for AHI and MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      were performed using ANOVA and Tukey's test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      severity accounted for 83.1% of MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      improvement changes. Most AHI reductions and MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      improvements were due to AT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Initial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      severity alone accounted for the most changes in MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      increase. In most cases, RPE had a marginal effect on AHI and MinSaO\n                      <jats:sub>2<\/jats:sub>\n                      when adjusted for confounders.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.27239","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T08:33:38Z","timestamp":1725611618000},"page":"3507-3517","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Impact of adenotonsillectomy and palatal expansion on the apnea\u2010hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross\u2010over randomized controlled trial"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1219-7990","authenticated-orcid":false,"given":"Maria Cecilia","family":"Magalh\u00e3es","sequence":"first","affiliation":[{"name":"Department of 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