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