Paediatric sleep-disordered breathing due to upper airway obstruction in the orthodontic setting: a review

Area of Science:

• Pediatric Pulmonology and Sleep Medicine
• Otolaryngology
• Orthodontics and Craniofacial Development

Background:

• Pediatric sleep-disordered breathing (SDB) is characterized by increased upper airway resistance during sleep, manifesting as snoring.
• SDB exists on a spectrum from primary snoring (PS) to obstructive sleep apnoea (OSA), impacting gas exchange, sleep quality, and overall health.
• Key predisposing factors include adenotonsillar hypertrophy, obesity, and craniofacial abnormalities.

Purpose of the Study:

• To review the spectrum of pediatric sleep-disordered breathing (SDB).
• To discuss the clinical impact of SDB on children's behavior, neurocognition, cardiovascular health, and quality of life.
• To evaluate current diagnostic and treatment modalities for pediatric SDB.

Main Methods:

• Review of existing literature on pediatric sleep-disordered breathing.
• Discussion of diagnostic gold standard: overnight polysomnography.
• Analysis of treatment options including adenotonsillectomy, nasal CPAP, nasal steroids, and dentofacial orthopedics.

Main Results:

• Adenotonsillar hypertrophy, obesity, and craniofacial disharmonies are significant contributors to pediatric SDB.
• SDB negatively impacts behavior, neurocognition, cardiovascular health, and quality of life in children.
• Adenotonsillectomy is the primary treatment, but long-term efficacy data for dentofacial orthopedics are lacking.

Conclusions:

• Pediatric SDB is a significant clinical issue with wide-ranging health implications.
• While adenotonsillectomy is the first-line treatment, further research is needed on other modalities.
• Additional studies are warranted to identify patient characteristics that would benefit most from orthodontic treatment for SDB.