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Facial Patterns and Obstructive Sleep Apnea in Children Seeking for Orthodontic Treatment: Data From 3671
Derek Mahony1,2, Niroj Bhattarai2, Cascella Simona3
1Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary.
Insights
Children with severe Obstructive Sleep Apnea (OSA) often exhibit a Class II facial profile and long lower face height. Orthodontists should consider breathing issues in children with these craniofacial features.
Area of Science:
- Orthodontics
- Pediatric Sleep Medicine
- Craniofacial Imaging
Background:
- Obstructive Sleep Apnea (OSA) is a prevalent condition in children.
- Facial morphology may influence the development and severity of OSA.
- Early identification of OSA risk factors in children is crucial.
Purpose of the Study:
- To investigate the correlation between vertical and sagittal facial profile characteristics and the diagnosis/severity of OSA in children.
- To assess if specific craniofacial patterns are associated with higher Apnea/Hypopnea Index (AHI) values.
Main Methods:
- A cohort of 3671 children (aged 7-9 years) undergoing their first orthodontic visit was analyzed.
- Polysomnography (PSG) was used to determine the Apnea/Hypopnea Index (AHI).
- Lateral cephalograms were analyzed using the Modified Sassouni Analysis to assess facial profile characteristics.
Main Results:
- No significant differences in AHI were found based on gender or age.
- Children with severe OSA (AHI ≥ 11) predominantly displayed a long facial pattern (87.3%).
- Severe OSA was associated with a Class II facial profile and maxillomandibular retrusion, while lower AHI values correlated with a Class I profile and maxillomandibular protrusion.
Conclusions:
- A Class II profile, maxillomandibular retrusion, and increased anterior lower facial height are strongly linked to severe OSA in children aged 7-9 years.
- Orthodontists should be vigilant for potential breathing issues in children presenting with these craniofacial features.
- This study highlights the importance of considering craniofacial morphology in the early detection of pediatric OSA.
Aim:
To evaluate the association between vertical and sagittal facial profile characteristics and the diagnosis/severity of Obstructive Sleep Apnea (OSA) based on hospital-based polysomnography (PSG) in children attending their first orthodontic visit.
Materials And Methods:
3671 children aged 7 to 9 years who attended a private practice for a first orthodontic consultation were included. Apnea/Hypopnea Index (AHI) was measured from PSG, while vertical and skeletal facial profile characteristics were assessed according to the Modified Sassouni Analysis on lateral cephalogram. Analysis of Variance (ANOVA) was used to compare sagittal and vertical patterns among patient subgroups divided according to AHI (AHI = 0, AHI 1-3, AHI 4-5, AHI 6-10, AHI ≥ 11).
Results:
No statistically significant difference was found in the AHI according to gender (p = 0.84) and age (p = 0.61). It was observed that 87.3% of children with AHI ≥ 11 had a long facial pattern, whereas those with low AHI values (AHI = 0 or 1 ≤ AHI ≤ 3) were mostly classified as having a normal vertical pattern (p < 0.001). Furthermore, children with AHI ≥ 11 presented with a Class II facial profile or maxillomandibular retrusion, while children with maxillomandibular protrusion and a Class I profile had lower AHI values (AHI = 0 or 1 ≤ AHI ≤ 3, p < 0.001).
Conclusions:
Class II profile, maxillomandibular retrusion, and increased anterior lower facial height are highly present in severe OSA children between the ages of 7 to 9 years. Therefore, orthodontists are encouraged to consider the possibility of breathing issues in children presenting with such craniofacial features.
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