Join me for a summary looking into the increasingly popular topic of paediatric obstructive sleep apnoea, a review of orthodontic treatments available, and how effective they are in this growing field of both medicine and dentistry. This episode is a summary of Alberto Capriglio’s lecture from the AAO and Carlos Flores Mir’s lecture at the IOF earlier this year.
OSA - Defined upper airway dysfunction causing complete or partial airway obstruction during sleep
Sleep = Slow wave sleep – constructive phase of sleep (recuperation of the mind)
· Growth hormones secreted
· Glial cells within brain restored
· Cortical synapses increase in number – Moberget 2019
Outcomes to paediatric patients of SDB: (AASM)
· delays in development, Poor academic performance, Aggressive behaviour, attention- deficit/hyperactivity disorder, , emotional problems in adolescence
First line medical treatment – adenotonsillectomy
· 40% residual OSA
Effect palatal expansion
1. Roof the mouth = base of the nose - Increase in nasal airway volume - Reduction in OSA, if obstruction in naso-pharynx,
2. Short term reduction in OSA (not cure AASM)
a. 20% improvement in AHI, 85% of cases Villa 2015
b. 15% got worse by 20%
c. 57.5% residual AHI greater than 1 - not resolution
3. Caprioglio 2019 long term AHI return to initial scores, from 7 to 5 long term
4. Change in metabolism when combined with Vit D3
a. Vit D3 with RME increases reduction in AHI, sustained long term, Caprioglio 2019 AHI 61.9% Vs 35.5% long term
Expansion other outcomes - school performance Bariani 2024
· AJODO – RME improves academic performance –
o BEHAVOUR 1 of 8 parameters improved only for academic performance - change small 0.68
o COGNITIVE 1 in 8 improve
Mandibular advancement
Move mandible forwards and open space behind the tongue – oropharynx
· Anatomical – increase size of oropharangeal airway
· YAnyAn 2019 mandibular advancement for pOSA systematic review: 1.75 AHI reduction (CI) −2.07, −1.44) – modest change
· However long term use required of the paediatric patient
Orofacial features in children with obstructive sleep apnea. Fagundes Flores-Mir 2022
o No craniofacial features specific to pOSA – ANB,
o However medical diagnosis through polysomnography may under-estimate incidence,
o Broader diagnosis such as snoring, may over-estimate OSA
AADSM 2024 – consensus statement
· Expansion
o Prevention: No consensus
o Management: No consensus
o Cure: Insufficient
· Mandibular advancement
o Prevention, management, cure – unclear
More about OSA?
To hear more about OSA, please check out the last interview on orthodontics in interview with Sanjivan Kandasamy, where we had a deep dive into OSA and where we are in our understanding today from the research
Interview with Sanjivan Kandasamy on OSA
