Can Orthodontics Treat Paediatric Obstructive Sleep Apnoea? 8 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) 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