Can Orthodontics Treat Pediatric Obstructive Sleep Apnea? 7 MINUTE SUMMARY

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Can Orthodontics Treat Paediatric Obstructive Sleep Apnoea? 7 MINUTE SUMMARY

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)
   1. 20% improvement in AHI, 85% of cases Villa 2015
   2. 15% got worse by 20%
   3. 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
   61. 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 –
  • BEHAVOUR 1 of 8 parameters improved only for academic performance – change small 0.68
  • 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: 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

• No craniofacial features specific to pOSA – ANB,
• However medical diagnosis through polysomnography may under-estimate incidence,
• Broader diagnosis such as snoring, may over-estimate OSA

AADSM 2024 – consensus statement

• Expansion
  • Prevention: No consensus
  • Management: No consensus
  • Cure: Insufficient
• Mandibular advancement
  • 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

Contributions

Contents: Farooq Ahmed

Edited and produced: Farooq Ahmed