Encyclopedia
Obstructive sleep apnea (OSA) is a sleeping breathing disorder. In children, adenotonsillar hypertrophy remains the main anatomical risk factor of OSA. The aim of this study was to assess the current scientific data and to summarize systematically the evidence of efficiency of adenotonsillectomy (AT) and orthodontic treatment (i.e.: rapid maxillary expansion (RME) and mandibular advancement (MA)) in the treatment of pediatric OSA. A literature search was conducted in several databases, including PubMed, Embase, Medline, Cochrane and LILACS up to 5th April 2020. The initial search yielded 509 articles, with 10 articles being identified as eligible after screening. AT and orthodontic treatment were more effective together than separately to cure OSA in pediatric patients. There was a higher decrease of Apnea Hypoapnea Index (AHI) and Respiratory Disturbance Index (RDI), a major increase of the lowest oxygen saturation and the oxygen desaturation index (ODI) after undergoing both treatments. Nevertheless, reappearance of OSA could occur several years after reporting adequate treatment. In order to avoid recurrence, myofunctional therapy (MT) could be recommended as follow-up. However, further studies with good clinical evidence are required to confirm this finding.
- surgical
- orthodontic treatments
- apnea
1. Definition
Obstructive sleep apnea (OSA) is described as a sleeping breathing disorder, characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction [1]. This syndrome is commonly correlated with intermittent hypoxemia and sleep fragmentation [2].
2. Introduction
The prevalence of OSA has been estimated, in a general orthodontic population, by questionnaires and it was found to be 10.8%, which is more than double that reported by similar methods in a healthy pediatric population [3].
OSA has also been associated with frequent snoring, disturbed sleep, daytime neurobehavioral problems, neurocognitive impairments, academic underperformance, hypertension, cardiac dysfunction and systemic inflammation. Daytime sleepiness may occur but is uncommon in young children [4]. Etiological factors include any condition that reduces the caliber of the upper airways, such as craniofacial dysmorphism, hypertrophy of lymphoid tissues, obesity, hypotonic neuromuscular diseases and neuromotor control alterations during sleep. However, adenotonsillar hypertrophy remains the main anatomical risk factor [4–7].
Therefore, adenotonsillectomy (AT) is the recommended first-line treatment for pediatric OSA in children with adenotonsillar hypertrophy [4,8–10]. It has been demonstrated that AT reduced the severity of OSA in most children, and reduced symptoms and improved behavior, quality of life and polysomnographic findings [9]. However, a significant number of patients with pediatric OSA undergoing AT exhibit residual persistent post-surgery OSA [10].
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This entry is adapted from the peer-reviewed paper 10.3390/jcm9082387
