Screening of obstructive sleep apnea (OSA) risk in adolescent population and study of association with craniofacial and upper airway morphology

A Comprehensive Review of Pediatric Obstructive Sleep Apnea: From Assessment to Intervention

Pediatric obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by upper airway obstruction during sleep, leading to oxygen desaturation and sleep disruptions. This comprehensive review examines the epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, consequences, management strategies, challenges, and future directions of pediatric OSA. Prevalence rates vary globally, with notable associations found between OSA and obesity. The review explores the anatomical and neuromuscular factors contributing to airway obstruction, emphasizing the importance of timely identification and intervention to mitigate long-term health implications. Diagnostic tools such as polysomnography (PSG) are essential, although challenges in accessibility exist. Pediatric OSA is linked to various health issues, including cardiovascular complications, metabolic disturbances, and neurocognitive impairments. Treatment options range from surgical interventions like adenotonsillectomy to non-pharmacological therapies and pharmacotherapy. Challenges in diagnosis and treatment warrant research into innovative diagnostic approaches and refining clinical prediction rules. Addressing these areas will enhance clinical management and outcomes for children with OSA.

Sleepiness in children with severe malocclusion compared with in children with neutral occlusion

INTRODUCTION

The study aimed to compare daytime sleepiness in children with severe malocclusion with healthy children with neutral occlusion (controls) and to analyze associations between daytime sleepiness and craniofacial morphology in children with severe malocclusion.

METHODS

In 120 children with severe malocclusion (73 girls, 47 boys; mean age, 11.96 years; mean body mass index [BMI] score, 18.97 kg/m2) and 35 controls (18 girls, 17 boys; mean age, 11.97 years; mean BMI score, 20.28 kg/m2), sleep and daytime sleepiness were recorded using Epworth Sleepiness Scale and Berlin Questionnaire. Occlusion was registered clinically, and craniofacial morphology was assessed on lateral cephalograms. Differences in daytime sleepiness and sleep between the groups and associations between daytime sleepiness and sleep and craniofacial morphology were analyzed by a general linear model adjusted for age, gender, and BMI score.

RESULTS

Daytime sleepiness occurred significantly more often in children with malocclusion than in control subjects (P = 0.015). There was a tendency for children with malocclusion to feel extremely tired during the day more often than controls (P = 0.054). There was no significant difference between the groups in sleeping hours during night-time, but the amount of sleep was negatively associated with age (P <0.001) and BMI score (P = 0.004). Only maxillary inclination was significantly associated with daytime sleepiness (P = 0.043).

CONCLUSIONS

Daytime sleepiness occurred significantly more often in children with severe malocclusion than in those with neutral occlusion, and the association between daytime sleepiness and craniofacial morphology may exist. The results might prove valuable in interdisciplinary collaboration between medical doctors and orthodontists in diagnostics, prevention, and treatment of children at risk for sleep-disordered breathing.

Pediatric sleep-disordered breathing in Shanghai: characteristics, independent risk factors and its association with malocclusion

OBJECTIVES

This study aimed to determine the prevalence and independent risk factors of SDB, and explore its association with malocclusion among 6-11-year-old children in Shanghai, China.

METHODS

A cluster sampling procedure was adopted in this cross-sectional study. Pediatric Sleep Questionnaire (PSQ) was applied to evaluate the presence of SDB. Questionnaires including PSQ, medical history, family history, and daily habits/environment were completed by parents under instruction, and oral examinations were implemented by well-trained orthodontists. Multivariable logistic regression was applied to identify independent risk factors for SDB. Chi-square tests and Spearman's Rank Correlation were used to estimate the relationship between SDB and malocclusion.

RESULTS

A total of 3433 subjects (1788 males and 1645 females) were included in the study. The SDB prevalence was about 17.7%. Allergic rhinitis (OR 1.39, 95% CI 1.09-1.79), adenotonsillar hypertrophy (OR 2.39, 95% CI 1.82-3.19), paternal snoring (OR 1.97, 95% CI 1.53-2.53), and maternal snoring (OR 1.35, 95% CI 1.05-1.73) were independent risk factors for SDB. The SDB prevalence was higher in children with retrusive mandibles than in proper or excessive ones. No significant difference was observed in the correlation between SDB and lateral facial profile, mandible plane angle, constricted dental arch form, the severity of anterior overjet and overbite, degree of crowding and spacing, and the presence of crossbite and open bite.

CONCLUSIONS

The prevalence of SDB in primary students in the Chinese urban population was high and highly associated with mandible retrusion. The independent risk factors included Allergic rhinitis, adenotonsillar hypertrophy, paternal snoring, and maternal snoring. More efforts should be made to enhance public education about SDB and related dental-maxillofacial abnormalities.

Specific dento-craniofacial characteristics in non-syndromic children can predispose to sleep-disordered breathing

AIM

To ascertain and illustrate specific clinical dento-craniofacial characteristics associated with sleep-disordered breathing (SDB) in non-syndromic children.

METHODS

Narrative review of literature on SDB, dental occlusion and craniofacial morphology retrieved through online literature database search for these terms. The review focused on clinical examples and graphical illustrations in order to ascertain the association between dento-craniofacial characteristics and SDB. Only publications concerning healthy non-syndromic children without any somatic or psychological diagnosis were included.

RESULTS

Dento-craniofacial characteristics such as anterior open bite, large overjet, cross bite and facial appearance such as convex profile due to mandibular retrognathia and inclination, narrow and high palate can predispose to SDB in non-syndromic children. Furthermore, extended head posture, mouth breathing and general adenoidal face may be symptoms or predisposing factors to SDB in non-syndromic children.

CONCLUSION

Dento-craniofacial characteristics as anterior open bite, large overjet due to mandibular retrognathia, cross bite, and narrow and high palate can predispose to SDB in non-syndromic children. Facial characteristics predisposing to SDB can be a convex facial profile, extended head posture, mouth breathing and general adenoidal face. Interdisciplinary collaboration between medical doctors and dentists can prove valuable in diagnostics, prevention and treatment of SDB in non-syndromic children.

Development, testing, and feasibility of a customized mobile application for obstructive sleep apnea (OSA) risk assessment: A hospital-based pilot study

Introduction

Obstructive Sleep Apnea (OSA), the most prevalent form of sleep-related breathing disorder has practical and financial limitations in diagnosis by polysomnography, hence OSA risk-assessment can identify OSA-related symptoms early.

Objectives

To develop a mobile application for OSA-risk assessment and tests its validity, feasibility, and application in a hospital-based pilot sample.

Study design and methods

The study comprised of two parts.

Part i

Development of a mobile application "OSA-Risk Assessment Tool" using automated questionnaires.

Part ii

A pilot study to screen OSA-risk in 200 patients (100 adults,100 children) from the orthodontic OPD of a Govt. Dental Hospital, using the mobile application. Internal validation by manual and mobile-based methods was done on 30 random patients. Non-parametric tests assessed the statistical differences between OSA-risk and nonOSA-risk variables.

Results

The prevalence of OSA-risk was 21.4% in adults and 8% in children. In adults, OSA-risk showed significantly greater neck circumference (p = 0.0001), waist circumference(p = 0.001), body mass index(p = 0.008), daytime sleepiness, headache, and mouth breathing(p = 0.0001). In children, OSA-risk is associated with a dry mouth on awakening, daytime sleepiness, and mouth breathing, and nocturnal enuresis. The low OSA-risk patients were suggested standardized preventive management counseling and orthodontic interventions while medium to high-risk underwent sleep-specialist referrals.

Conclusions

This study supports the feasibility and usability of the mobile application "OSA-risk assessment tool" in a hospital setup. This cost-effective tool can be advocated for self-evaluation, early detection, and awareness in pandemic times. The future upgraded versions may include preventive modules and real-time coordination with the nearest sleep clinics and specialists.

Sleep-disordered breathing and malocclusion in children and adolescents-a systematic review

BACKGROUND

Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB.

OBJECTIVES

The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6-15 years compared to healthy controls.

METHODS

Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6-15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age-matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence.

RESULTS

The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty-four studies were selected for full-text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low.

CONCLUSION

No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion.

Prototype of Customized Mobile Application for Obstructive Sleep Apnea (OSA) Risk Assessment During the COVID-19 Pandemic

Obstructive sleep apnea (OSA), the most prevalent form of sleep-related breathing disorder (SRBD), is associated with cardiovascular, neurocognitive, and metabolic complications. Evidence suggests that these comorbidities are also risk factors for enhanced severity in COVID-19 patients. Hence, initial diagnosis or screening of OSA-risk is a major requirement of current times, which can be fulfilled by a noncommercial, easily accessible mobile application for self-assessment of OSA-risk. The current article mentions a prototype of an “OSA-Risk Assessment Tool,” a mobile application developed after prior testing of needs analysis and comprising various interfaces for OSA-risk assessment in all age groups, and further refined for user applicability through a cognitive, pluralistic walkthrough and heuristic evaluation by the authors and four volunteers. It has huge scope of application in orthodontic clinics, primary healthcare centers in middle and low-income strata of developing countries, and multiple educational and licensing institutions for the larger benefit of the society.