This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).

https://erj.ersjournals.com/content/erj/47/1/69.full.pdf

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management.

The classification of malocclusion

OBJECTIVE To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data. DATA SOURCES Web of Science, Scopus, MEDLINE, and The Cochrane Library. REVIEW METHODS The searches were performed through June 18, 2014. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. RESULTS Nine adult studies (120 patients) reported polysomnography, snoring, and/or sleepiness outcomes. The pre- and post-MT apneahypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 24.5 ± 14.3/h to 12.3 ± 11.8/h, mean difference (MD) -14.26 [95% confidence interval (CI) -20.98, -7.54], P < 0.0001. Lowest oxygen saturations improved from 83.9 ± 6.0% to 86.6 ± 7.3%, MD 4.19 (95% CI 1.85, 6.54), P = 0.0005. Polysomnography snoring decreased from 14.05 ± 4.89% to 3.87 ± 4.12% of total sleep time, P < 0.001, and snoring decreased in all three studies reporting subjective outcomes. Epworth Sleepiness Scale decreased from 14.8 ± 3.5 to 8.2 ± 4.1. Two pediatric studies (25 patients) reported outcomes. In the first study of 14 children, the AHI decreased from 4.87 ± 3.0/h to 1.84 ± 3.2/h, P = 0.004. The second study evaluated children who were cured of OSA after adenotonsillectomy and palatal expansion, and found that 11 patients who continued MT remained cured (AHI 0.5 ± 0.4/h), whereas 13 controls had recurrent OSA (AHI 5.3 ± 1.5/h) after 4 y. CONCLUSION Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.

/pdf/myofunctional-therapy-to-treat-obstructive-sleep-apnea-a-4osd1vuwql.pdf

Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

https://bura.brunel.ac.uk/bitstream/2438/15865/1/Meta-analysis%20of%20randomised%20controlled%20trials%20of%20oral%20mandibular%20advancement%20devices%20and%20continuous%20positive%20airway%20pressure%20for%c2%a0obstructive%20sleep%20apnoea-hypopnoea.pdf

Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea.

Prevalence of malocclusion among mouth breathing children: do expectations meet reality?

Introduction  Maximum bite force (MBF) is the maximum force performed by the subject on the fragmentation of food, directly related with the mastication and determined by many factors. Objective  Analyze the MBF of subjects according to age groups. Methods  One hundred individuals from the city of Sao Paulo were equally divided according to age groups and gender. Each individual submitted to a myotherapy evaluation composed of anthropometric measurements of height and weight to obtain body mass index (BMI), using a tape and a digital scale (Magna, G-life, Sao Paulo), and a dental condition and maximum bite force evaluation, using a digital dynamometer model DDK/M (Kratos, Sao Paulo, Brazil), on Newton scale. The dental and bite force evaluations were monitored by a professional from the area. Analysis of variance was used with MBF as a dependent variable, age group and gender as random factors, and BMI as a control variable. Results  Till the end of adolescence, it was possible to observe a decrease in MBF in both sexes, with the male force greater than the female force. In young adults, the female force became greater the males, then decreased in adulthood. There was no correlation between MBF and BMI. Conclusion  There are MBF variations that characterizes the human development stages, according to age groups.

/pdf/maximum-bite-force-analysis-in-different-age-groups-2se6whbzba.pdf

Maximum Bite Force Analysis in Different Age Groups

Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea.

Few studies have investigated myofunctional therapy in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the effect of myofunctional therapy on continuous positive airway pressure (CPAP) adherence. The study was registered at ClinicalTrials.gov
 (NCT01289405). Male patients with OSAS were randomly divided into four treatment groups: placebo, patients undergoing placebo myofunctional therapy (N = 24); myofunctional therapy, undergoing myofunctional therapy (N = 27); CPAP, undergoing treatment with CPAP (N = 27); and combined, undergoing CPAP therapy and myofunctional therapy (N = 22). All patients underwent evaluations before and after 3 months of treatment evaluation and after 3 weeks of washout. Evaluations included Epworth sleepiness scale (ESS), polysomnography, and myofunctional evaluation. The 100 men had a mean age of 48.1 ± 11.2 years, body mass index of 27.4 ± 4.9 kg/m2, ESS score of 12.7 ± 3.0, and apnea-hypopnea index (AHI) of 30.9 ± 20.6. All treated groups (myofunctional therapy, CPAP, and combined myofunctional therapy with CPAP) showed decreased ESS and snoring, and the myofunctional therapy group maintained this improvement after the “washout” period. AHI reduction occurred in all treated groups and was more significant in CPAP group. The myofunctional therapy and combined groups showed improvement in tongue and soft palate muscle strength when compared with the placebo group. The association of myofunctional therapy to CPAP (combined group) showed an increased adherence to CPAP compared with the CPAP group. Our results suggest that in patients with OSAS, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to CPAP.

Myofunctional therapy improves adherence to continuous positive airway pressure treatment

Lack of agreement between objective and subjective measures in the evaluation of masticatory function: A preliminary study.

Objectives: This study evaluated new bone formation at the midpalatal suture after surgically assisted rapid maxillary expansion (SARME) by optical density analysis. Methods: The study population consisted of 18 patients, 10 males and 8 females. All patients presented maxillary atresia with posterior crossbite and were submitted to SARME. Maxillary occlusal radiographs were taken at three stages (before SARME, immediately after SARME and after 3 months). Three patients did not attend the session at the 3-month period for achievement of the occlusal radiography and thus were excluded, leading to a final sample of 15 patients. Two regions were selected and analysed at each stage. Region A measured 8 £ 1m m 2 and was located 1.2 cm from the tangent to the maxillary central incisors at the region of the midpalatal suture. Region B measured 5 £ 9m m 2 and was located 4.3 cm from the tangent to the maxillary central incisors at the region of the midpalatal suture. An aluminium scale (step wedge) with eight steps varying from 1 mm to 8 mm was adapted at the end of the films. Radiographs were taken on a

Silvana Bommarito

Papers

Maximum Bite Force Analysis in Different Age Groups

Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea.

Myofunctional therapy improves adherence to continuous positive airway pressure treatment

Lack of agreement between objective and subjective measures in the evaluation of masticatory function: A preliminary study.

Evaluation of optical density of the midpalatal suture 3 months after surgically assisted rapid maxillary expansion.