Abstract
Purpose
The aim of this study was to assess children in an orthodontic teaching clinic to determine the relationship between sleep-disordered breathing (SDB) symptoms and craniofacial morphology.
Methods
All parents were asked to complete a SDB questionnaire at the commencement of orthodontic therapy. A cephalometric analysis included face heights, hyoid position, soft palate lengths, mandibular, vertical airway, overjet, and overbite. Study model measurements included dental width, depth, and palatal height. The subjects were divided into two groups according to their dentition stage: early or late mixed.
Results
Data from 173 children (male 50.3%, mean age 10.1 ± 1.7 years) that completed the OSA-18 questionnaire and the cephalometric (CA) and model (MA) analyses were evaluated. The questionnaire suggested that only two children in the orthodontic pool had an increased chance of exhibiting SDB. However, loud snoring, mouth breathing, and difficulty awakening were reported in more than 20% of the children. Overall, a higher total score correlated with retroclined upper incisors (CA) and high palatal height (MA, p < 0.05). Although there was no significant score differences between the groups, a higher total score correlated with a long soft palate (CA, p < 0.05) in the early mixed dentition group and a high palatal height (MA) in the late mixed dentition group (p < 0.05).
Conclusion
Even though few patients were suspected as having SDB, symptoms were related to many cephalometric variables and study model measurements. Since the etiology of SDB is believed to involve multiple factors, such patients may exhibit some risk of developing SDB in the future.
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References
Schechter MS (2002) Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 109:e69
Urschitz MS, Guenther A, Eggebrecht E, Wolff J, Urschitz-Duprat PM, Schlaud M, Poets CF (2003) Snoring, intermittent hypoxia and academic performance in primary school children. Am J Respir Crit Care Med 168:464–468
Rosen CL, D'Andrea L, Haddad GG (1992) Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis 146:1231–1234
Richards W, Ferdman RM (2000) Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children. Clin Pediatr (Phila) 39:103–108
Lipton AJ, Gozal D (2003) Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev 7:61–80
Marcus CL, Ward SL, Mallory GB, Rosen CL, Beckerman RC, Weese-Mayer DE, Brouillette RT, Trang HT, Brooks LJ (1995) Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. J Pediatr 127:88–94
Ozdemir H, Altin R, Sogut A, Cinar F, Mahmutyazicioglu K, Kart L, Uzun L, Davsanci H, Gundogdu S, Tomac N (2004) Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients. Pediatr Radiol 34:393–399
Schiffman PH, Rubin NK, Dominguez T, Mahboubi S, Udupa JK, O'Donnell AR, McDonough JM, Maislin G, Schwab RJ, Arens R (2004) Mandibular dimensions in children with obstructive sleep apnea syndrome. Sleep 27:959–965
Hultcrantz E, Larson M, Hellquist R, Ahlquist-Rastad J, Svanholm H, Jakobsson OP (1991) The influence of tonsillar obstruction and tonsillectomy on facial growth and dental arch morphology. Int J Pediatr Otorhinolaryngol 22:125–134
Linder-Aronson S (1972) Effects of adenoidectomy on dentition and nasopharynx. Trans Eur Orthod Soc 177–186
Cozza P, Ballanti F, Prete L (2004) A modified monobloc for treatment of young children with obstructive sleep apnea. J Clin Orthod 38:241–247
Villa MP, Malagola C, Pagani J, Montesano M, Rizzoli A, Guilleminault C, Ronchetti R (2007) Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. Sleep Med 8:128–134
Pirelli P, Saponara M, Guilleminault C (2004) Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep 27:761–766
Guilleminault C, Quo S, Huynh NT, Li K (2008) Orthodontic expansion treatment and adenotonsillectomy in the treatment of obstructive sleep apnea in prepubertal children. Sleep 31:953–957
Franco RA Jr, Rosenfeld RM, Rao M (2000) First place—resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 123:9–16
Moorrees CFA (1959) The dentition of the growing child; a longitudinal study of dental development between 3 and 18 years of age. Harvard University Press, Cambridge
Lofstrand-Tidestrom B, Thilander B, Ahlqvist-Rastad J, Jakobsson O, Hultcrantz E (1999) Breathing obstruction in relation to craniofacial and dental arch morphology in 4-year-old children. Eur J Orthod 21:323–332
Moyers RE, University of Michigan. Center for Human Growth and Development (1976) Standards of human occlusal development. Center for Human Growth and Development, Ann Arbor
Dahlberg G (1940) Statistical methods for medical and biological students. G. Allen & Unwin ltd., London
Pirila-Parkkinen K, Pirttiniemi P, Nieminen P, Tolonen U, Pelttari U, Lopponen H (2008) Dental arch morphology in children with sleep-disordered breathing. Eur J Orthod 31(2):160–167
Zettergren-Wijk L, Forsberg CM, Linder-Aronson S (2006) Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea—a 5-year follow-up study. Eur J Orthod 28:319–326
Shintani T, Asakura K, Kataura A (1997) Evaluation of the role of adenotonsillar hypertrophy and facial morphology in children with obstructive sleep apnea. ORL J Otorhinolaryngol Relat Spec 59:286–291
Finkelstein Y, Wexler D, Berger G, Nachmany A, Shapiro-Feinberg M, Ophir D (2000) Anatomical basis of sleep-related breathing abnormalities in children with nasal obstruction. Arch Otolaryngol Head Neck Surg 126:593–600
Kulnis R, Nelson S, Strohl K, Hans M (2000) Cephalometric assessment of snoring and nonsnoring children. Chest 118:596–603
Pirila K, Tahvanainen P, Huggare J, Nieminen P, Lopponen H (1995) Sleeping positions and dental arch dimensions in children with suspected obstructive sleep apnea syndrome. Eur J Oral Sci 103:285–291
Behlfelt K, Linder-Aronson S, McWilliam J, Neander P, Laage-Hellman J (1989) Dentition in children with enlarged tonsils compared to control children. Eur J Orthod 11:416–429
Kawashima S, Peltomaki T, Sakata H, Mori K, Happonen RP, Ronning O (2002) Craniofacial morphology in preschool children with sleep-related breathing disorder and hypertrophy of tonsils. Acta Paediatr 91:71–77
Butler GE, McKie M, Ratcliffe SG (1990) The cyclical nature of prepubertal growth. Ann Hum Biol 17:177–198
Bresolin D, Shapiro GG, Shapiro PA, Dassel SW, Furukawa CT, Pierson WE, Chapko M, Bierman CW (1984) Facial characteristics of children who breathe through the mouth. Pediatrics 73:622–625
Bacon WH, Krieger J, Turlot JC, Stierle JL (1988) Craniofacial characteristics in patients with obstructive sleep apneas syndrome. Cleft Palate J 25:374–378
Zucconi M, Caprioglio A, Calori G, Ferini-Strambi L, Oldani A, Castronovo C, Smirne S (1999) Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case-control study. Eur Respir J 13:411–417
Acknowledgments
The authors would like to thank Mrs. Ingrid Ellis for her editorial assistance in the final presentation of this manuscript. Financial support for this study was received from MITACS Graduate Research Internship Program and from Klearway royalties paid to the University of British Columbia.
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Tsuda, H., Fastlicht, S., Almeida, F.R. et al. The correlation between craniofacial morphology and sleep-disordered breathing in children in an undergraduate orthodontic clinic. Sleep Breath 15, 163–171 (2011). https://doi.org/10.1007/s11325-010-0345-4
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DOI: https://doi.org/10.1007/s11325-010-0345-4