Cervical headgear therapy as a factor in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) has been a subject of increasing interest from the orthodontic point of view, but less attention has been paid to the possible influence of orthodontic treatment on its occurrence. The aim here was to study possible associations between the use of cervical headgear and nocturnal cessations of airflow and the severity of the latter.

The subjects were 30 children (12 boys, 18 girls, mean age 8.2, sd 1.61 years), divided into three groups: a group of 10 children undergoing headgear therapy, selected for this examination because of symptoms of OSAS while using headgear, an age-matched control group of 10 healthy children and a group of 10 with OSAS. Standard cephalograms of the headgear group prior to the orthodontic therapy and the corresponding cephalograms of healthy controls were analysed. A polygraphic (PG) sleep evaluation was used to assess the tendency for OSAS. Apnea and hypopnea periods were summated as apnea index (AI) and number of desaturations as desaturation index (ODI). All the subjects spent one night sleeping under laboratory conditions, those with orthodontic treatment spending the first half of the night with the headgear and the latter half without.

The position of the mandible was found to be slightly more posterior in the headgear group than in the control group. The children in the headgear group were found to have significantly more apnea/hypopnea periods during the hours when the appliance was used, and the ODI-index showed increased values in this group.

We suggest that headgear therapy may contribute to the occurrence of sleep apnea, when a strong predisposition, such as mandibular retrognathia to the development of upper airway occlusion already exists.