The Open Dentistry Journal

ISSN: 1874-2106 ― Volume 14, 2020

Parents’ Perceptions of Breathing Pattern Changes, Sleep Quality, and Fatigue in Children after Rapid Maxillary Expansion: A Survey and Case Series Study

Narmin Helal1, *, Osama Basri2, Lubabah Samir Gadi1, Amira Fahad Alhameed1, John Marshal Grady3
1 Department of Pediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
2 Department of Craniofacial Orthodontic Dentistry, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
3 Private Practice, Pittsburgh, PA, USA



Rapid Maxillary Expansion (RME) aims to re-establish balance between the widths of the jaws. It is mainly utilized to treat skeletal and dental manifestations associated with transverse maxillary constriction and to improve facial structures involving the nasal cavity.


This study aimed to investigate parents’ perceptions of breathing pattern changes after their child had undergone RME and the associated effects on sleep quality and fatigue. We also evaluated nasal cavity changes in three dimensions in six randomly selected patients.


Ninety-one children aged 5-13 years with transverse maxillary deficiency and no major systemic diseases or syndromes were recruited. Their parents completed a 16-item questionnaire pre-treatment and 6 months post-treatment. The questionnaire included items pertaining to changes in (1) sleep apnea and breathing patterns, (2) sleep quality and fatigue, and (3) behavior. The cone beam computed tomography scans from six randomly chosen patients were also subjected to stereolithographic reconstruction of the midface pre-RME and post-RME.


Responses in the three domains exhibited good reliability. Significant improvements were observed in 59% of the items post vs. pre-RME. The overall rates of dry mouth in the morning, snoring half of the time, and heavy breathing decreased by ≥30%. The percentage change in headache in the morning, snoring loudly, and snoring half of the time was >80%. In addition, in the series of six cases, the mean difference in nasal cavity area post-RME was 4.1 mm2.


Post-RME, parents perceived that their children exhibited improved behavior and were less fatigued during the day. Enhanced sleep quality and breathing patterns were also observed, but to a lesser extent.

Keywords: Breathing, Sleep disordered breathing, Paediatric sleep questionnaire, Sleep quality, Rapid maxillary expansion, Survey.

Article Information

Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 85
Last Page: 92
Publisher Id: TODENTJ-13-85
DOI: 10.2174/1874210601913010085

Article History:

Received Date: 27/09/2018
Revision Received Date: 04/01/2019
Acceptance Date: 28/01/2019
Electronic publication date: 28/02/2019
Collection year: 2019

© 2019 Helal et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Pediatric Dentistry, King Abdulaziz University P.O. Box 80209, Jeddah 21589, Saudi Arabia;
Tel: +966536630055; E-mail:

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