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Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and
Carlos Flores-Mir1, Mohamed Korayem, Giseon Heo
1Division of Orthodontics, Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, 5-528 Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada. cf1@ualberta.ca
Insights
Pediatric obstructive sleep apnea syndrome (OSAS) is linked to specific craniofacial traits, including a retrusive chin and steep mandibular plane. Dentists should consider these features when evaluating children for OSAS.
Area of Science:
- Craniofacial morphology
- Pediatric sleep medicine
- Cephalometrics
Background:
- Obstructive sleep apnea syndrome (OSAS) in children is a growing concern.
- Understanding craniofacial characteristics associated with pediatric OSAS is crucial for early diagnosis.
- This review consolidates current knowledge on craniofacial morphology in nonsyndromic pediatric OSAS.
Purpose of the Study:
- To systematically review and consolidate existing research on craniofacial morphological characteristics in nonsyndromic pediatric patients with OSAS.
- To identify key cephalometric variables associated with pediatric OSAS.
- To provide insights for dental professionals in identifying potential OSAS cases.
Main Methods:
- Systematic review of clinical studies involving pediatric patients (<18 years) with and without OSAS.
- Inclusion of studies with polysomnography confirmation of OSAS and comparison to control groups or normative data.
- Exclusion of syndromic patients or those with prior orthodontic/orthognathic treatment.
- Meta-analysis of eight common cephalometric variables, using random-effect and fixed-effects models based on I(2) values.
Main Results:
- Nine articles were included in the review.
- Meta-analysis revealed statistically significant differences in three cephalometric variables (MP-SN, SNB, ANB) in children with OSAS compared to controls.
- These variables, including mandibular plane angle and sagittal jaw relationships, were generally increased in children with OSAS.
- Caution is advised due to the limited number of cephalometric variables analyzed and heterogeneity in some measures.
Conclusions:
- Specific craniofacial morphologies, such as a retrusive chin, steep mandibular plane, vertical growth pattern, and Class II malocclusion tendency, are associated with pediatric OSAS.
- Dentists play a role in identifying potential OSAS cases based on craniofacial features.
- Referral to an otolaryngologist is recommended for patients exhibiting these craniofacial traits along with symptoms like snoring, nasal obstruction, allergies, asthma, or obesity.
Background:
The authors conducted a systematic review to consolidate the current knowledge regarding craniofacial morphological characteristics associated with obstructive sleep apnea syndrome (OSAS) in nonsyndromic pediatric patients.
Types Of Studies Reviewed:
The authors included clinical studies in which participants were younger than 18 years, polysomnography was performed to determine the presence and severity of OSAS and the study group was compared with a control group or normative growth center data. The authors excluded studies with syndromic participants or participants who had received orthodontic treatment, orthognathic treatment or both previously.
Results:
The authors identified nine articles. They conducted a meta-analyses of the data from all but one of the studies to evaluate the eight most common cephalometric variables in children with OSAS. The I(2) values were 79.53 percent for the angle from the basion point to the sella nasion (SN) line, 89.54 percent for the angle between the SN and palatal plane lines and 96.82 percent for the angle between the mandibular plane and SN lines (MP-SN). Therefore, for these three variables, the authors conducted a random-effect model meta-analysis. For the remaining five variables (MP-SN, the angle from SN to Apoint, the angle from SN to B point [SNB], the angle from A point to nasion point to B point [ANB] and the angle from articulare point to gonion point to gnathion point), I(2) values were all less than 40 percent, and therefore the authors conducted a fixed-effects model meta-analysis. Three of the evaluated cephalometric variables (MP-SN, SNB and ANB) had statistically significant differences in comparison with those in a control group. Although the values of these variables were increased in children with OSAS, results of the meta-analysis should be considered cautiously owing to the limited number of cephalometric variables included.
Practical Implications:
Dentists who identify patients with a craniofacial morphology consistent with pediatric OSAS (retrusive chin, steep mandibular plane, vertical direction of growth and a tendency toward Class II malocclusion) should inquire further into their patients' medical histories. When the craniofacial morphology is accompanied by a history of snoring, inability to breathe through the nose, significant allergies, asthma or obesity, the dentist should refer the patient to an otolaryngologist for assessment.
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