Can Orthodontics Treat Paediatric Obstructive Sleep Apnoea? 8 MINUTE SUMMARY

orthodontics In 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)

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