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Published on: February 14, 2019
Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children
H Eimar1, M A Q Al-Saleh1,2, A R G Cortes3
11 School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Insights
Children with sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA), show reduced mandibular cortical width, potentially indicating altered bone health. This finding suggests MCW may aid in diagnosing SDB in pediatric populations.
Area of Science:
- Pediatric Sleep Medicine
- Orthodontics
- Bone Physiology
Background:
- Sleep-disordered breathing (SDB) is linked to reduced bone density in adults.
- The association between SDB and bone health in children remains under-investigated.
- Mandibular cortical width (MCW) serves as a proxy for skeletal bone density.
Purpose of the Study:
- To investigate if children at risk of SDB or diagnosed with obstructive sleep apnea (OSA) exhibit reduced mandibular cortical width (MCW).
- To explore the relationship between SDB severity and MCW in pediatric patients.
Main Methods:
- Two retrospective cross-sectional studies were conducted.
- Study 1: Compared MCW in 24 children with polysomnographically diagnosed OSA versus 72 controls.
- Study 2: Assessed MCW in 101 children screened for SDB using the Pediatric Sleep Questionnaire (PSQ). MCW was measured from panoramic radiographs.
Main Results:
- Children with OSA had significantly thinner MCW (3.5 ± 0.6 mm) compared to healthy controls (2.9 ± 0.6 mm; P = 0.002).
- Severe SDB associated with OSA showed a negative correlation with MCW (β = -0.290, P = 0.049).
- Higher PSQ scores negatively correlated with MCW (β = -0.391, P < 0.001).
Conclusions:
- Children with SDB, including OSA, demonstrate reduced mandibular cortical width.
- This reduction may reflect underlying alterations in bone homeostasis or reduced bone formation.
- MCW shows potential as an adjunctive diagnostic parameter for SDB in children.
Introduction:
Evidence from the adult population suggests that sleep-disordered breathing (SDB) (i.e., obstructive sleep apnea [OSA]) is negatively associated with bone mineral density. Whether a similar association exists in children with SDB has not been investigated. Using the mandibular cortical width (MCW) as a proxy for skeletal bone density, we investigated if children at risk of SDB or diagnosed with OSA have a reduced mandibular cortical width compared to children without SDB.
Methods:
Two retrospective cross-sectional studies were performed. The first study included comparison of MCW between 24 children with polysomnographically (PSG) diagnosed OSA and 72 age- and sex-matched control children. The second study included a cohort of children in which SDB was suggested by the Pediatric Sleep Questionnaire (PSQ) ( n = 101). MCW was measured from panoramic radiographs.
Results:
Multiple-predictors regression analysis from the first study indicated that in children with a severe form of SDB, as induced by OSA severity, there was a negative association with MCW (β = -0.290, P = 0.049). Moreover, PSG-diagnosed OSA children had thinner MCW (2.9. ± 0.6mm) compared to healthy children (3.5 ± 0.6 mm; P = 0.002). These findings were further supported by the second study illustrating that PSQ total scores were negatively associated with MCW (β = -0.391, P < 0.001).
Conclusions:
Findings suggest that children at risk for or diagnosed with SDB exhibit reduced mandibular cortical width that purportedly may reflect alterations in bone homeostasis.
Knowledge Transfer Statement:
We report that sleep-disordered breathing (including its severe form, obstructive sleep apnea) in children is associated with reduced mandibular cortical width. This association might be a direct consequence of reduced bone health to sleep-disordered breathing or a reflection that reduced bone formation underlies the development of sleep-disordered breathing. Our findings suggest that mandibular cortical width can be used as an adjunct diagnostic parameter for the diagnosis of sleep-disordered breathing.
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