Orthodontic Maxillofacial Skeletal Expansion for Obstructive Sleep Apnea in Patients with Heart Failure: A Multidisciplinary Care Framework Integrating Cephalometric/Echocardiographic Imaging, Pharmacist-Led Medication Review, and Nurse-Led Compliance Mon

Abstract

Background: Obstructive sleep apnea (OSA), heart failure (HF), and major depressive disorder (MDD) frequently coexist and can interact through intermittent hypoxemia, autonomic activation, sleep fragmentation, neuroendocrine dysregulation, treatment burden, and reduced adherence. In selected adults, transverse maxillary deficiency may contribute to increased nasal resistance and upper-airway vulnerability.

Objective: To develop an evidence-informed, multidisciplinary clinical framework for evaluating and managing skeletally mature adults with OSA, HF, and MDD in whom transverse maxillary deficiency is considered a potentially modifiable anatomical contributor to sleep-disordered breathing.

Framework: The proposed pathway integrates sleep medicine/pulmonology, cardiology, orthodontics/dentofacial orthopedics, oral and maxillofacial surgery, otolaryngology, dentistry/dental sleep medicine, diagnostic and oral/maxillofacial radiology, psychiatry, clinical pharmacy, nursing, family medicine/primary care, psychology, nutrition, rehabilitation, anesthesiology/perioperative medicine, public health, health services administration, biomedical engineering, and health informatics. Cone-beam computed tomography (CBCT) and cephalometric assessment are paired with transthoracic echocardiography (TTE), while polysomnography, medication reconciliation, psychometric assessment, and remote monitoring provide longitudinal clinical measures.

Evidence and limitations: MARPE, MSE, and DOME/SARPE can produce skeletal transverse changes in selected adults, and some studies report improvements in upper-airway anatomy or respiratory measures. However, the evidence base is heterogeneous, and there is currently no established evidence that maxillary expansion improves HF outcomes or MDD itself. Therefore, the framework is a research and care-coordination model rather than a recommendation to replace continuous positive airway pressure (CPAP), guideline-directed HF therapy, or evidence-based psychiatric treatment.

Conclusions: An anatomically informed, multidisciplinary pathway may improve patient selection, procedural safety, adherence, measurement, and coordination of care. Its clinical effectiveness and effects on cardiovascular and psychiatric outcomes require prospective, adequately powered, multicenter comparative studies.