The anecdotal evidence regarding rapid palatal expansion and the treatment of obstructive sleep apnea syndrome, or OSAS, snoring in children and increased oral airway resistance in adults following four-premolar-extraction orthodontic treatment offered by Dr. Shapira provides us with some insight into the microcosm of his "nearly 20 years" of practice. Although selected case series add valuable information to our clinical database, they fall on the opposite pole of the research spectrum in comparison to the randomized clinical trial. I would highly recommend to Dr. Shapira a review of the current literature for controlled studies regarding these clinical issues.
A significant finding in an article by Miles and colleagues1 was that "only mandibular body length demonstrated a clinically significant association with and diagnostic accuracy for OSAS [obstructive sleep apnea syndrome]."
Another study worth reading is by Hershey and colleagues.2 An interesting finding was "the change in nasal resistance of subjects who noticed an improvement in their ability to breathe through the nose was not significantly different from nasal resistance in children who did not notice any change in their breathing."
An article by Pirila and colleagues3 concluded, "Sleeping predominantly on one’s back was associated with a reduced maxillary intercanine width, while prolonged head extension during sleep correlated inversely with the overjet. We suggest that sleeping on the back causes a more posterior tongue position, reducing its moulding effect on the anterior dental arch."
These are but a small sample of the great wealth of literature in existence that both supports and rejects Dr. Shapira’s assertions on these clinical topics. In an evidence-based debate, the argument supported by data will always prevail over anecdote.
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