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
