Abstract
The most common cause of childhood obstructive sleep apnea syndrome (OSAS) is adenotonsillar hypertrophy. Aside from nocturnal symptoms, children with OSAS may present with lower school performance, behavioral disorder, cardiovascular complications and failure to thrive. First-line treatment is adenotonsillectomy; however, residual OSAS on postoperative polygraphy is reported in 20% to 40% of cases. In well-selected cases, orthodontic treatment can play an important role in the management of light to moderate childhood OSAS or residual OSAS after surgery, using growth activators or oral mandibular advancement appliances, rapid maxillary expansion and orofacial rehabilitation. Nevertheless, clinical studies with a high level of evidence of efficacy are lacking. To illustrate therapeutic sequences that may include an orthodontic phase, we present clinical cases encountered in our multidisciplinary outpatients clinic.
Highlights
Childhood obstructive sleep apnea syndrome (OSAS) affects 2% to 3% of the pediatric population
Certain patients presenting with mild to moderate OSAS or residual postoperative OSAS may benefit from orthodontic treatment, sometimes associated to orofacial rehabilitation, and should be correctly selected
Summary
Childhood obstructive sleep apnea syndrome (OSAS) affects 2% to 3% of the pediatric population It is characterized by increased upper airway resistance due to pharyngeal narrowing, leading to episodic snoring, apnea or hypopnea. (a) AP and (b) lateral photographs of Rayan (5.5 years), referred for (c) Friedman 3 tonsillar hypertrophy, with only mild clinical OSAS. (a) Lateral and (b) AP photographs of Damian (5 years), referred by pneumologist for discrepancy between clinical and ENT signs: i.e., small tonsils but strong symptoms. Nocturnal signs Snoring +++ Sweats +/Agitated sleep Oral breathing Respiratory breaks Difficulty breathing Frequent awakening Neck hyperextension Friedman : 0. Kahina presented with clinical OSAS (cf Table IV) not confirmed on sleep recording in 2014; strong snoring and upper airway resistance syndrome.
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