Research Article

Obstructive Sleep Apnea Syndrome (OSAS) Treated with Orthodontic Appliances in Children: A New Feasible Approach

Author: A.Balian

Obstructive Sleep Apnea Syndrome (OSAS) affects up to 4% of the paediatric population and, due to the high risk of cardio-vascular and neurological complications and negative outcomes on the developmental process associated, represents the most serious type of Sleep Disordered Breathing (SDB) and the most challenging for public health.Although the most common treatment for OSAS in childhood is Adenotonsillectomy (AT), this approach is limited by its surgical risks and by a high prevalence of recurrence or partial success, with persistence of signs and symptoms of obstructive apnea.The presence of cranio-facial abnormalities and malocclusion is considered an important risk factor for paediatric OSAS and its recurrence after AT. Children affected by OSAS often present specific oro-facial features such asnarrow maxilla, mandibular retrusion, anterior openbite, bilateral/ monolateral cross bite, that are frequently associated with dysfunctions such as oral breathing and atypical swallowing. Those alterations can represent an anatomical base which can contribute to the development of paediatric OSAS, especially in preschool child aged 3-6 years, when the hyperplasia of adenoids and tonsils is reported to be at its peak with a higher risk for obstruction. The purpose of the present research is to evaluate the possibility that an orthodontic treatment, primary aiming to the treatment of malocclusion and the related dysfunctions, can induce improvement or relief of respiratory nighttime distress, as a secondary effect. The sample consisted of 5 children affected by OSAS, 3 female and 2 male, average aged 4.5 years, who have never undergone AT or have had a recurrence of sign and symptoms 1 year after AT.All patients presented narrow maxilla, associated with monolateral/ bilateral crossbite and or anterior openbite. The patients underwent orthodontic treatment performed with an elastodontic appliance, which is a removable oral device made of PVC and widely used in children aged less than 6 years. The following variables were evaluated in each patient at the beginning (T0) and after 1 year (T2) of orthodontic treatment:occlusal parameters; Sleep Clinical Score (SCS); Night time poligraphic parameters: Snoring, Apnea/Hypopnea Index (AHI) andOswestry Disability Index (ODI).Four out of 5 patients showed high compliance to the orthodontic treatment and improved their occlusal relationship. In those patients also AHI and ODI index improved as well as the SCS score, revealing a reduction of sign and symptoms of OSAS. The only patient who did not improve his occlusal and respiratory findings also showed poor compliance to the orthodontic treatment. The study suggest that the treatment of malocclusion might produce improvements in sign and symptoms of OSAS in children aged 3-6 years and that preformed elastodontc appliances are a feasible therapeutic tool for this purpose