Obstructive sleep apnoea (OSA) is one of the most common causes of sleep-disordered breathing (SDB) in children. It is associated with significant morbidity, potentially impacting on long-term neurocognitive and behavioural development, as well as cardiovascular outcomes and metabolic homeostasis. The low grade systemic inflammation and increased oxidative stress seen in this condition are believed to underpin the development of these OSA-related morbidities. The significant variance in degree of end organ morbidity in patients with the same severity of OSA highlights the importance of the interplay of genetic and environmental factors in determining the overall OSA phenotype. This review seeks to summarize the current understanding of the aetiology and mechanisms underlying OSA, its risk factors, diagnosis and treatment.

Update on paediatric obstructive sleep apnoea

Background The authors conducted a systematic review to consolidate the current knowledge regarding craniofacial morphological characteristics associated with obstructive sleep apnea syndrome (OSAS) in nonsyndromic pediatric patients. Types of Studies Reviewed The authors included clinical studies in which participants were younger than 18 years, polysomnography was performed to determine the presence and severity of OSAS and the study group was compared with a control group or normative growth center data. The authors excluded studies with syndromic participants or participants who had received orthodontic treatment, orthognathic treatment or both previously. Results The authors identified nine articles. They conducted a meta-analyses of the data from all but one of the studies to evaluate the eight most common cephalometric variables in children with OSAS. The I 2 values were 79.53 percent for the angle from the basion point to the sella nasion (SN) line, 89.54 percent for the angle between the SN and palatal plane lines and 96.82 percent for the angle between the mandibular plane and SN lines (MP-SN). Therefore, for these three variables, the authors conducted a random-effect model meta-analysis. For the remaining five variables (MP-SN, the angle from SN to Apoint, the angle from SN to B point [SNB], the angle from A point to nasion point to B point [ANB] and the angle from articulare point to gonion point to gnathion point), I 2 values were all less than 40 percent, and therefore the authors conducted a fixed-effects model meta-analysis. Three of the evaluated cephalometric variables (MP-SN, SNB and ANB) had statistically significant differences in comparison with those in a control group. Although the values of these variables were increased in children with OSAS, results of the meta-analysis should be considered cautiously owing to the limited number of cephalometric variables included. Practical Implications Dentists who identify patients with a craniofacial morphology consistent with pediatric OSAS (retrusive chin, steep mandibular plane, vertical direction of growth and a tendency toward Class II malocclusion) should inquire further into their patients’ medical histories. When the craniofacial morphology is accompanied by a history of snoring, inability to breathe through the nose, significant allergies, asthma or obesity, the dentist should refer the patient to an otolaryngologist for assessment.

https://jada.ada.org/article/S0002-8177(14)60369-X/pdf

Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: A systematic review and meta-analysis

Objectives/Hypothesis
To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA)

Data Sources
PubMed/MEDLINE and eight additional databases

Review Methods
Three authors independently and systematically reviewed the international literature through February 21, 2016

Results
Seventeen studies reported outcomes for 314 children (76 ± 20 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients) For ≤3-year follow-up, the pre- and post-RME apnea–hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 89 ± 70/hr to 27 ± 33/hr (70% reduction) The cure rate (AHI 3-year follow-up (range = 65–12 years), the AHI was reduced from an M ± SD of 71 ± 57/hr to 15 ± 18/hr (79% reduction)

Conclusions
Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up) Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA Laryngoscope, 2016 Laryngoscope, 127:1712–1719, 2017

Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis

Orthodontics treatments for managing obstructive sleep apnea syndrome in children: A systematic review and meta-analysis

This article is an adaptation for psychiatrists of a consensus position statement aimed at paediatricians, family physicians and other health professionals working with youth that has been endorsed by the Canadian Academy of Child and Adolescent Psychiatry, College of Family Physicians of Canada, and Canadian Sleep Society.

Position statement on pediatric sleep for psychiatrists.

Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children

AIM Obstructive sleep apnoea syndrome (OSAS) is a common problem in children. It is characterised by a combination of partial airway obstruction associated with hypoxemia and hypoventilation and intermittent obstructive apnoea, which disrupts normal ventilation and sleep. The aim of the study was to evaluate the craniofacial features of preschool children with polysomnographic diagnosis of OSAS, using measurements from standardized lateral cephalograms according to the floating norms cephalometric analysis. MATERIALS AND METHODS 21 untreated caucasian children (mean age of 4.57 +/-0.6) with complete deciduous dentition were included in this study. All the subjects had diagnosis of OSAS with a positive RDI. Pretreatment cephalometric radiographs were evaluated. Statistical method Descriptive statistics includes mean and standard deviation of the cephalometric variables. CONCLUSION The present study showed that OSAS preschool children showed a skeletal Class II pattern with retrognathic mandible and increased skeletal divergency.

Craniofacial morphology in preschool children with obstructive sleep apnoea syndrome.

Aim to evaluate the effects of rapid maxillary expansion (RME) in a group of OSAS preschool children. Materials and methods Lateral cephalograms of 15 OSAS children (8 boys and 7 girls, age mean ± SD: 5.94 ± 1.64 years) were analysed at the start of treatment with RME (T0). All subjects were revaluated after a mean period of 1.57 ± 0.58 years (T1). At this time the sample was divided into 2 groups according to the change in the respiratory disturbance index (RDI): an improved group (I: 8 subjects) and a stationary/worsened group (SW: 7 subjects). Differences between I and SW children with respect to values of cephalometric variables at T0 and to variations between T0 and T1 were evaluated using Mann-Whitney U test. Differences between T0 and T1 values in the overall group of children and separately in I and SW groups were assessed using Wilcoxon test. Results At the start of treatment, the I group was characterised by more retrognathic jaws with lower values of SNA (p=0.055) and SNB (p=0.020) and higher age values (p=0.093) when compared to SW group. After treatment, the I group showed an increase in SNA and SNB angle significantly higher than SW group (p=0.004 and p=0.003, respectively). On the contrary, I and SW groups did not differ as for variation in the skeletal divergency and in the total facial height. Conclusion OSAS preschool children with retrognathic jaws could benefit from RME treatment.

Rapid maxillary expansion in children with Obstructive Sleep Apnoea Syndrome (OSAS).

Dilaceration is one of the causes of permanent maxillary incisor eruption failure. It is a developmental distortion of the form of a tooth that commonly occurs in permanent incisors as result of trauma to the primary predecessors whose apices lie close to the permanent tooth germ. We present a case of post-traumatic impaction of a dilacerated central maxillary left incisor in a young patient with a class II malocclusion.

/pdf/orthodontic-treatment-of-an-impacted-dilacerated-maxillary-4emrxoa314.pdf

Orthodontic treatment of an impacted dilacerated maxillary incisor: a case report.

Objective: The aim of this study was to compare the dimensions of the upper and lower arches in children affected by OSAS with different levels of severity of obstruction.Methods: Twenty-se...

Alessandra Marino

Papers

Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children

Craniofacial morphology in preschool children with obstructive sleep apnoea syndrome.

Rapid maxillary expansion in children with Obstructive Sleep Apnoea Syndrome (OSAS).

Orthodontic treatment of an impacted dilacerated maxillary incisor: a case report.

Obstructive sleep apnea severity and dental arches dimensions in children with late primary dentition: An observational study.