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Sleep-disordered breathing. A view at the beginning of the new Millennium
1Stanford Sleep Disorders Clinic and Research Center, Stanford, California, USA. cguil@leland.stanford.edu
Insights
Mild sleep-disordered breathing in children, including obstructive sleep apnea syndrome (OSAS) and upper airway resistance syndrome (UARS), is often overlooked. Early dental and orthodontic interventions targeting craniofacial growth can improve airway function and potentially prevent future surgeries.
Area of Science:
- Pediatric dentistry
- Orthodontics
- Sleep medicine
Background:
- Obstructed sleep apnea syndrome (OSAS) and upper airway resistance syndrome (UARS) are frequently undiagnosed in children.
- Pediatric patients with mild OSAS or UARS often present with subtle symptoms and less pronounced craniofacial alterations compared to adults.
- This demographic represents a critical window for early intervention to influence craniofacial development.
Purpose of the Study:
- To highlight the importance of early identification and intervention for pediatric OSAS and UARS.
- To explore the role of dentists and orthodontists in managing these conditions.
- To discuss non-surgical treatment modalities for improving upper airway function in children.
Main Methods:
- Utilizing orthopedic palatal and transverse expansion appliances to widen jaw bases.
- Employing orthodontic uprighting of lingually tipped teeth to enhance oropharyngeal space.
- Considering the alteration of tongue resting posture as an indirect benefit.
- Integrating these approaches with other non-invasive treatments.
Main Results:
- Dental and orthodontic interventions can modify craniofacial growth to enlarge the upper airway.
- Widening jaw bases and improving dental alignment can indirectly increase oropharyngeal space.
- Early treatment may potentially obviate the need for more aggressive surgical interventions later in life.
Conclusions:
- Dentists and orthodontists are uniquely positioned to identify and manage pediatric OSAS and UARS.
- Non-surgical orthopedic and orthodontic treatments offer a promising approach to improving airway function in children.
- Timely intervention can significantly impact long-term respiratory health and development.
Abstract:
Obstructed sleep apnea syndrome and UARS are often missed in clinical practice. The pediatric population presenting with UARS or mild OSAS is the most commonly ignored because the symptoms are insidious. Often, their craniofacial morphology is not as altered as in the adult population because the effects of airway obstruction may not have been fully established. This is, however, the group in which trials aimed at redistributing bone growth and functional readaptations may be attempted. Dentists and orthodontists have the greatest opportunity to see these young individuals and may help identify them and participate in treatment options. Undoubtedly, functional appliances are not the ideal solution, but if used appropriately with the goal of enlarging the upper airway, they may obviate the need for aggressive surgical treatments later in life. Orthopedic palatal and transverse expansion appliances can widen the jaw bases at the level of the basal bone. Orthodontically uprighting lingually tipped teeth to widen the alveolar bone housing the teeth can help improve the oropharyngeal space indirectly by altering the resting posture of the tongue. These measures in conjunction with other simultaneous, noninvasive modalities may prove to be effective.