{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:49:00Z","timestamp":1791236940150,"version":"4.1.0"},"reference-count":53,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: In many children aged 7\u20139 years diagnosed with obstructive sleep apnoea (OSA) the decision of which treatment to perform still remains unclear. This is particularly relevant when the children have both a narrow maxilla and enlargement of tonsils and adenoids. Current guidelines recommend adenotonsillectomy (TA) as first-line therapy, but residual OSA is common, prompting interest in adjunctive semi-rapid maxillary expansion (SRME). This study evaluated the effects of TA and SRME on the respiratory disturbance index (RDI) in prepubertal children with OSA, both individually and in combination, regardless of treatment sequence. Materials and Methods: In this retrospective cohort study, 80 children (aged 7\u20139 years) with polysomnography-confirmed obstructive sleep apnoea, narrow maxillary arches, and adenotonsillar enlargement underwent TA first followed by SRME (n = 39) or SRME first followed by TA (n = 41). Level 1 polysomnography was performed at baseline and 3 months after each intervention. Repeated-measures analyses investigated the RDI profiles of the two groups over time, in each case adjusting for relevant background variables. Results: Baseline mean RDI was 18.99 \u00b1 1.66 events\/hour. Adjusted for background variables (including, most importantly, BMI), the initial reduction was significantly greater after SRME than TA (adjusted mean difference 1.49 events\/hour, p = 0.002), and this difference persisted until after both treatments were applied (adjusted mean difference 1.42, p = 0.007). Conclusions: Combined TA and SRME produced substantial RDI reductions compared to individual interventions in children with dual soft-tissue and skeletal OSA contributors, with treatment order (as well as BMI) significantly associated with different final outcomes. These findings support a flexible, multidisciplinary approach to optimise airway management and reduce residual disease.<\/jats:p>","DOI":"10.3390\/jcm15082981","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T14:24:58Z","timestamp":1776176698000},"page":"2981","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Maxillary Arch Expansion and Adenotonsillectomy in Prepubertal Children Diagnosed with Paediatric Obstructive Sleep Apnoea: An Interventional Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8382-2160","authenticated-orcid":false,"given":"Derek","family":"Mahony","sequence":"first","affiliation":[{"name":"Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Tisza Lajos Krt. 64\u201366., 6720 Szeged, Hungary"},{"name":"Private Practice, Full Face Orthodontics Inner West, Haberfield, NSW 2045, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0032-8415","authenticated-orcid":false,"given":"Niroj","family":"Bhattarai","sequence":"additional","affiliation":[{"name":"Private Practice, Full Face Orthodontics Inner West, Haberfield, NSW 2045, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1266-0060","authenticated-orcid":false,"given":"Peter","family":"Petocz","sequence":"additional","affiliation":[{"name":"Conservatorium of Music, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"ref_1","unstructured":"Gouthro, K., Kadam, S.J., Sankari, A., and Slowik, J.M. (2025). Pediatric Obstructive Sleep Apnea. StatPearls, StatPearls Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/B978-0-444-64032-1.00025-4","article-title":"Polysomnography","volume":"160","author":"Rundo","year":"2019","journal-title":"Handbook of Clinical Neurology"},{"key":"ref_3","first-page":"120","article-title":"Obstructive Sleep Apnea Diagnosis and Management","volume":"114","author":"Goyal","year":"2017","journal-title":"Mo. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.jsmc.2009.04.007","article-title":"Pediatric polysomnography","volume":"4","author":"Beck","year":"2009","journal-title":"Sleep Med. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"289","DOI":"10.14639\/0392-100X-N0262","article-title":"Assessment of Obstructive Sleep Apnoea (OSA) in Children: An Update","volume":"39","author":"Savini","year":"2019","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101871","DOI":"10.1016\/j.smrv.2023.101871","article-title":"Prevalence of Obstructive Sleep Apnea (OSA) among Preschool Aged Children in the General Population: A Systematic Review","volume":"73","author":"Magnusdottir","year":"2024","journal-title":"Sleep Med. Rev."},{"key":"ref_7","first-page":"19","article-title":"Consequences of Obstructive Sleep Apnea in Children","volume":"46","author":"Blechner","year":"2016","journal-title":"Curr. Probl. Pediatr. Adolesc. Health Care"},{"key":"ref_8","unstructured":"Iannelli, G. (2026, February 12). Sleep-Disordered Breathing in Children: Long-Term Health Impacts. Distance Learn. Telehealth. Available online: https:\/\/ostrowonline.usc.edu\/sleep-disordered-breathing-in-children-long-term-health-impacts\/."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Solano-P\u00e9rez, E., Coso, C., Castillo-Garc\u00eda, M., Romero-Peralta, S., Lopez-Monzoni, S., Lavi\u00f1a, E., Cano-Pumarega, I., S\u00e1nchez-de-la-Torre, M., Garc\u00eda-R\u00edo, F., and Mediano, O. (2023). Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed. Biomedicines, 11.","DOI":"10.3390\/biomedicines11061708"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"zsac035","DOI":"10.1093\/sleep\/zsac035","article-title":"Neurobehavioral Morbidity of Pediatric Mild Sleep-Disordered Breathing and Obstructive Sleep Apnea","volume":"45","author":"Yu","year":"2022","journal-title":"Sleep"},{"key":"ref_11","first-page":"109","article-title":"Obstructive Sleep Apnea in Children: A Critical Update","volume":"5","author":"Tan","year":"2013","journal-title":"Nat. Sci. Sleep"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"872","DOI":"10.3345\/kjp.2010.53.10.872","article-title":"Treatment of Obstructive Sleep Apnea in Children","volume":"53","author":"Ahn","year":"2010","journal-title":"Korean J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5591251","DOI":"10.1155\/2021\/5591251","article-title":"Pediatric Obstructive Sleep Apnea Syndrome: Emerging Evidence and Treatment Approach","volume":"2021","author":"Giuca","year":"2021","journal-title":"Sci. World J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nosetti, L., Zaffanello, M., di Valserra, F.D.B., Simoncini, D., Beretta, G., Guacci, P., Piacentini, G., Agosti, M., Nosetti, L., and Zaffanello, M. (2023). Exploring the Intricate Links between Adenotonsillar Hypertrophy, Mouth Breathing, and Craniofacial Development in Children with Sleep-Disordered Breathing: Unraveling the Vicious Cycle. Children, 10.","DOI":"10.3390\/children10081426"},{"key":"ref_15","unstructured":"(2026, January 04). Adenotonsillar Hypertrophy\u2014An Overview|ScienceDirect Topics. Available online: https:\/\/www.sciencedirect.com\/topics\/pharmacology-toxicology-and-pharmaceutical-science\/adenotonsillar-hypertrophy."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"89","DOI":"10.7180\/kmj.24.120","article-title":"Treatment of Pediatric Obstructive Sleep Apnea","volume":"39","author":"Koh","year":"2024","journal-title":"Kosin Med. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"863","DOI":"10.3345\/kjp.2010.53.10.863","article-title":"Obstructive Sleep Apnea Syndrome in Children: Epidemiology, Pathophysiology, Diagnosis and Sequelae","volume":"53","author":"Chang","year":"2010","journal-title":"Korean J. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2765","DOI":"10.21037\/tp-2025-163","article-title":"The Impact of Adenoid Hypertrophy on Obstructive Sleep Apnea in Children with Allergic Rhinitis: A Retrospective Analysis of Ventilation Function and Treatment Outcomes","volume":"14","author":"Wei","year":"2025","journal-title":"Transl. Pediatr."},{"key":"ref_19","first-page":"S1","article-title":"Clinical Practice Guideline: Tonsillectomy in Children","volume":"144","author":"Baugh","year":"2011","journal-title":"Otolaryngol.\u2014Head Neck Surg. Off. J. Am. Acad."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1542\/peds.109.4.e69","article-title":"Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome Technical Report: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome","volume":"109","author":"Schechter","year":"2002","journal-title":"Pediatrics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1002\/lary.23709","article-title":"Current Practice Patterns for Sleep-Disordered Breathing in Children","volume":"123","author":"Friedman","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e714","DOI":"10.1542\/peds.2012-1672","article-title":"Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome","volume":"130","author":"Marcus","year":"2012","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.otohns.2008.12.038","article-title":"Adenotonsillectomy for Obstructive Sleep Apnea in Obese Children: A Meta-Analysis","volume":"140","author":"Costa","year":"2009","journal-title":"Otolaryngol.\u2014Head Neck Surg. Off. J. Am. Acad."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.otohns.2006.02.033","article-title":"The Effectiveness of Tonsillectomy and Adenoidectomy in the Treatment of Pediatric Obstructive Sleep Apnea\/Hypopnea Syndrome: A Meta-Analysis","volume":"134","author":"Brietzke","year":"2006","journal-title":"Otolaryngol.\u2013Head Neck Surg. Off. J. Am. Acad."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Mahony, D., Bhattarai, N., Simona, C., Rosaria, B., Borb\u00e9ly, P., Petocz, P., Yoon, A., and K\u00e1rp\u00e1ti, K. (2025). Facial Patterns and Obstructive Sleep Apnea in Children Seeking for Orthodontic Treatment: Data From 3671 Polysomnographic Recordings. Orthod. Craniofac. Res.","DOI":"10.1111\/ocr.70020"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.5664\/jcsm.9904","article-title":"Craniofacial Features in Children with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis","volume":"18","author":"Fagundes","year":"2022","journal-title":"J. Clin. Sleep Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"88","DOI":"10.4103\/jisppd.jisppd_381_24","article-title":"Comparison of Palatal Dimension in Children with Obstructive and Habitual Mouth Breathing","volume":"43","author":"Kottayi","year":"2025","journal-title":"J. Indian Soc. Pedod. Prev. Dent."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Quinzi, V., Saccomanno, S., Manenti, R.J., Giancaspro, S., Paskay, L.C., Marzo, G., Quinzi, V., Saccomanno, S., Manenti, R.J., and Giancaspro, S. (2020). Efficacy of Rapid Maxillary Expansion with or without Previous Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome Based on Polysomnographic Data: A Systematic Review and Meta-Analysis. Appl. Sci., 10.","DOI":"10.3390\/app10186485"},{"key":"ref_29","first-page":"e465","article-title":"Rapid Maxillary Expansion and Obstructive Sleep Apnea: A Review and Meta-Analysis","volume":"21","author":"Zancanella","year":"2016","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1002\/lary.26352","article-title":"Rapid Maxillary Expansion for Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis","volume":"127","author":"Camacho","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101855","DOI":"10.1016\/j.smrv.2023.101855","article-title":"Orthodontic Appliances for the Treatment of Pediatric Obstructive Sleep Apnea: A Systematic Review and Network Meta-Analysis","volume":"72","author":"Yu","year":"2023","journal-title":"Sleep Med. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s11325-010-0419-3","article-title":"Adeno-Tonsillectomy and Rapid Maxillary Distraction in Pre-Pubertal Children, a Pilot Study","volume":"15","author":"Guilleminault","year":"2011","journal-title":"Sleep Breath."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"112248","DOI":"10.1016\/j.ijporl.2025.112248","article-title":"Rapid Palate Expansion\u2019s Impact on Nasal Breathing: A Systematic Review","volume":"190","author":"Inchingolo","year":"2025","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/0002-9416(83)90272-5","article-title":"Relapse Following Maxillary Expansion. A Study of Twenty-Five Consecutive Cases","volume":"83","author":"Mew","year":"1983","journal-title":"Am. J. Orthod."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1038\/sj.bdj.4803996","article-title":"Semi-Rapid Maxillary Expansion","volume":"143","author":"Mew","year":"1977","journal-title":"Br. Dent. J."},{"key":"ref_36","first-page":"70","article-title":"Rapid Maxillary Expansion for Obstructive Sleep Apnea among children\u2014Systematic Review and Meta-analysis","volume":"13","author":"Bahammam","year":"2020","journal-title":"Sleep Sci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hariharan, A., Muwaquet Rodriguez, S., and Hijazi Alsadi, T. (2024). The Role of Rapid Maxillary Expansion in the Management of Obstructive Sleep Apnoea: Monitoring Respiratory Parameters-A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14010116"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1017\/S0022215100080804","article-title":"Results of 310 Cases of Rapid Maxillary Expansion Selected for Medical Reasons","volume":"89","author":"Gray","year":"1975","journal-title":"J. Laryngol. Otol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Galeotti, A., Gatto, R., Caruso, S., Piga, S., Maldonato, W., Sitzia, E., Viarani, V., Bompiani, G., Aristei, F., and Marzo, G. (2023). Effects of Rapid Palatal Expansion on the Upper Airway Space in Children with Obstructive Sleep Apnea (OSA): A Case-Control Study. Children, 10.","DOI":"10.3390\/children10020244"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1053\/j.sodo.2024.08.003","article-title":"Functional Outcomes of Maxillary Expansion in Anatomic Phenotypes: Current Evidence, Clinical Protocols and Crossroads!","volume":"31","author":"Choi","year":"2025","journal-title":"Semin. Orthod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1007\/s00784-019-03004-w","article-title":"Evaluation of Palatal Support Tissues for Placement of Orthodontic Mini-Implants in Mouth Breathers with High-Narrow Palates versus Nose Breathers with Normal Palates: A Retrospective Study","volume":"24","author":"Kang","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1590\/S2179-64912011000400004","article-title":"Hard Palate Dimensions in Nasal and Mouth Breathers from Different Etiologies","volume":"23","author":"Berwig","year":"2011","journal-title":"J. Soc. Bras. Fonoaudiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1093\/sleep\/21.8.831","article-title":"Treatment of Obstructive Sleep Apnea Syndrome by Rapid Maxillary Expansion","volume":"21","author":"Cistulli","year":"1998","journal-title":"Sleep"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Colonna, A., Vianello, M., Lombardo, L., Cerritelli, L., Pollis, M., and Manfredini, D. (2025). Effects of Rapid Maxillary Expansion on Respiratory and Bruxism Indexes in Children with Obstructive Sleep Apnea: A Pilot Study. Cranio J. Craniomandib. Pract., 1\u20138.","DOI":"10.1080\/08869634.2025.2552537"},{"key":"ref_45","first-page":"2021","article-title":"Effect of Adenoids and Tonsil Tissue on Pediatric Obstructive Sleep Apnea Severity Determined by Computational Fluid Dynamics","volume":"16","author":"Iwasaki","year":"2020","journal-title":"J. Clin. Sleep Med. JCSM Off. Publ. Am. Acad. Sleep Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1164\/rccm.200912-1930OC","article-title":"Adenotonsillectomy Outcomes in Treatment of Obstructive Sleep Apnea in Children: A Multicenter Retrospective Study","volume":"182","author":"Bhattacharjee","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e211","DOI":"10.1055\/s-0043-1768207","article-title":"The Effect of Tonsillectomy and Adenoidectomy on Upper Airway Obstruction Patterns in Children with Obstructive Sleep Apnea","volume":"27","author":"Mothersole","year":"2023","journal-title":"Int. Arch. Otorhinolaryngol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1002\/lary.25979","article-title":"Risk Factors for Residual Obstructive Sleep Apnea after Adenotonsillectomy in Children","volume":"126","author":"Imanguli","year":"2016","journal-title":"Laryngoscope"},{"key":"ref_49","first-page":"973","article-title":"Craniofacial Contribution to Residual Obstructive Sleep Apnea after Adenotonsillectomy in Children: A Preliminary Study","volume":"10","author":"Maeda","year":"2014","journal-title":"J. Clin. Sleep Med. JCSM Off. Publ. Am. Acad. Sleep Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/j.1440-1843.2011.02093.x","article-title":"Obesity and Obstructive Sleep Apnoea: Mechanisms for Increased Collapsibility of the Passive Pharyngeal Airway","volume":"17","author":"Isono","year":"2012","journal-title":"Respirology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.sleep.2014.11.019","article-title":"Rapid Maxillary Expansion Outcomes in Treatment of Obstructive Sleep Apnea in Children","volume":"16","author":"Villa","year":"2015","journal-title":"Sleep Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s11325-013-0915-3","article-title":"Adenotonsillectomy and Orthodontic Therapy in Pediatric Obstructive Sleep Apnea","volume":"18","author":"Villa","year":"2014","journal-title":"Sleep Breath."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.sleep.2022.02.011","article-title":"Impact of Rapid Palatal Expansion on the Size of Adenoids and Tonsils in Children","volume":"92","author":"Yoon","year":"2022","journal-title":"Sleep Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2981\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T08:15:33Z","timestamp":1776413733000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2981"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":53,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15082981"],"URL":"https:\/\/doi.org\/10.3390\/jcm15082981","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]}}}