Model of oronasal rehabilitation in children with obstructive sleep apnea syndrome undergoing rapid maxillary expansion: Research review

A narrative review on obstructive sleep apnoea syndrome in paediatric population

Obstructive sleep apnoea syndrome is a respiratory sleep disorder that affects 1-5% of children. It occurs equally in males and females, with higher incidence in school age and adolescence. OSAS may be caused by several factors, but in children, adenotonsillar hypertrophy, obesity, and maxillo-mandibular deficits are the most common. In general, there is a reduction in the diameter of the airway with reduced airflow. This condition worsens during sleep due to the muscular hypotonia, resulting in apnoeas or hypoventilation. While snoring is the primary symptom, OSAS-related manifestations have a wide spectrum. Some of these symptoms relate to the nocturnal phase, including disturbed sleep, frequent changes of position, apnoeas and oral respiration. Other symptoms concern the daytime hours, such as drowsiness, irritability, inattention, difficulties with learning and memorisation, and poor school performance, especially in patient suffering from overlapping syndromes (e.g., Down syndrome). In some cases, the child's general growth may also be affected. Early diagnosis of this condition is crucial in limiting associated symptoms that can significantly impact a paediatric patient's quality of life, with the potential for the condition to persist into adulthood. Diagnosis involves evaluating several aspects, beginning with a comprehensive anamnesis that includes specific questionnaires, followed by an objective examination. This is followed by instrumental diagnosis, for which polysomnography is considered the gold standard, assessing several parameters, including the apnoea-hypopnoea index (AHI) and oxygen saturation. However, it is not the sole tool for assessing the characteristics of this condition. Other possibilities, such as night-time video recording, nocturnal oximetry, can be chosen when polysomnography is not available and even tested at home, even though with a lower diagnostic accuracy. The treatment of OSAS varies depending on the cause. In children, the most frequent therapies are adenotonsillectomy or orthodontic therapies, specifically maxillary expansion.

Management of the Pediatric Patient with Suspected Diagnosis of Obstructive Sleep Apnea Syndrome

AIM

The aim of this paper is to describe the multidisciplinary management pathway for pediatric patients with suspected obstructive sleep apnea syndrome (OSAS) conducted by the Pediatric and Orthodontic Department of the Dental Clinic of Padua.

MATERIALS AND METHODS

All pediatric subjects undergo a comprehensive medical history, including the completion of the Pediatric Sleep Questionnaire (PSQ), and a physical examination. Patients with suspected OSAS are placed on a waiting list for home respiratory polygraphy testing. The respiratory polygraphy examination is conducted over two consecutive nights and interpreted by a neurologist. Additionally, patients diagnosed with OSAS undergo a case study involving intraoral and extraoral photography, as well as radiographic evaluation.

RESULTS

Between September 2021 and May 2023, a total of 134 subjects (including 76 males), with an average age of 9.2 years, were identified as diagnostic suspects. Among these, 38 patients (28.3%) tested positive based on respiratory polygraphic results. Depending on the severity and etiopathogenetic characteristics of the disease, the positive cases were referred to various specialists.

CONCLUSION

In the daily clinical practice of dentistry, particularly in orthodontics and pedodontics, the establishment of a defined management pathway for pediatric patients with OSAS is crucial. The collaboration of a multidisciplinary team with a shared objective of achieving accurate diagnosis and implementing targeted treatment in a timely manner is essential. Regular re-evaluation of patients through clinical and instrumental examinations is recommended.

Recommendation of Neurorehabilitation according to the Padovan-Method Neurofunctional Reorganisation® for Treating Neurodevelopmental Disorders: A Systematic Review

OBJECTIVE

The PADOVAN-METHOD NEUROFUNCTIONAL REORGANI¬SATION® is a promising approach in speech therapy treating neuro¬developmental disorders with traumatic or congenital origin. Its use is based on a long-time experience of certified therapists. However, its efficacy and safety has not been assessed in a systematic review. This report aims to gain evidence for the use of the therapy method. Methods and analysis: Guidelines of PRISMA, the Cochrane Collaboration Handbook, MECIR and GRADE were followed. General databases (Cochrane Library, PubMed, AWMF, Anthromedics, etc.) and further 38 databases including grey literature were searched. Hand search was done additionally and contact to experts used to retrieve unpublished manuscripts. All trials investigating the effect of the method in comparison to either no intervention, alternative as state of the art or placebo intervention in English, Portuguese and German language were included. No restriction regarding study design was applied. Data related to the intervention outcome and the study method was extracted and analysed idependently. Risk of Bias was assessed using ROBINS-I for non-RCTs, adherence to CARE-Guidelines was analysed for case series or reports and keeping the Declaration of Helsinki was checked for all items. Results are presented both in evidence profiles and summary of findings tables according to GRADE.

RESULTS

Amongst 98 records assessed for eligibility, four studies and 14 case reports were identified with a total of n = 196 participants. Duration of reported interventions was between two days and two years. Microcephalia, down-syndrome, unspecified neurological disorders and myo-functional disorders were main conditions of the patients with neurodevelopmental disorders. Only indirect overlapping of operationalised criteria was found. Conclusions are therefore limited.

CONCLUSION

The Padovan-Method® is a holistic therapy approach claiming its feasibility to a large group of disorders making a proof of efficacy difficult. An application of therapy according to the Padovan-Method® by trained therapists might be considered by clinicians (weak recommendation) and a contribution to a relief of symptoms or improvements of condition of named conditions might be gained. Therefore, development and validation of therapy protocols and further investigation are required. PROSPERO Registration: CRD42020156124.

Can respiratory muscle training therapy effectively manage obstructive sleep apnea syndrome after stroke?: A protocol of systematic review and meta-analysis

BACKGROUND

This study will explore the effectiveness and safety of respiratory muscle training therapy (RMTT) for the treatment of patients with obstructive sleep apnea syndrome (OSAS) after stroke.

METHODS

In this study, we will systematically and comprehensively search Cochrane Library, PubMed, EMBASE, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for relevant literature from their inception to March 1, 2020 without any limitations to language and publication status. We will consider any randomized controlled trials focusing on the effectiveness and safety of RMTT for the treatment of patients with OSAS after stroke. The study quality will be checked using Cochrane risk of bias tool, and statistical analysis will be performed utilizing RevMan 5.3 software.

RESULTS

This study will summarize and synthesize the current evidence of RMTT for the treatment of patients with OSAS following stroke.

CONCLUSION

The findings of this study will assess the present evidence for the benefits and harms of RMTT for treating OSAS after stroke, and will inform clinical practice and future research.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42020170355.

Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases

BACKGROUND

Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer-reviewed evidence. Here, we explore the safety and efficacy of lingual frenuloplasty and myofunctional therapy for the treatment of these conditions in a large and diverse cohort of patients with restricted tongue mobility.

METHODS

Four hundred twenty consecutive patients (ages 29 months to 79 years) treated with myofunctional therapy and lingual frenuloplasty for indications of mouth breathing, snoring, dental clenching, and/or myofascial tension were surveyed. All procedures were performed by a single surgeon using a scissors and suture technique. Safety and efficacy was assessed >2 months postoperatively by means of patient-reported outcome measures.

RESULTS

In all, 348 surveys (83% response rate) were completed showing 91% satisfaction rate and 87% rate of improvement in quality of life through amelioration of mouth breathing (78.4%), snoring (72.9%), clenching (91.0%), and/or myofascial tension (77.5%). Minor complications occurred in <5% of cases including complaints of prolonged pain or bleeding, temporary numbness of the tongue-tip, salivary gland issues, minor wound infection or inflammation, and need for revision to excise scar tissue. There were no major complications.

CONCLUSION

Lingual frenuloplasty with myofunctional therapy is safe and potentially effective for the treatment of mouth breathing, snoring, clenching, and myofascial tension in appropriately selected patient candidates. Further studies with objective measures are merited.

LEVEL OF EVIDENCE

3.

Scientific production of Brazilian speech language pathologists in sleep medicine

Introduction:

Previous diagnosis and intervention in patients with sleep-disordered breathing involves several health professionals. Speech-Language and Hearing Sciences (SLHS) performance has been solidified through scientific production.

Objective:

To describe the inclusion of Brazilian Speech-Language Pathologists (SLP) in the field of sleep disorders, through the description of studies, scientific publications and participation in scientific events.

Data Synthesis:

A search and an analysis of the Brazilian SLP publications in the field of sleep disorders were carried out, including articles, monographs, dissertations, thesis and abstracts published in annals of events. The databases Lilacs, SciELO, Pubmed, Google Scholar tool and Lattes platform were accessed, with final search in January 2018. The analysis consisted of a description of the year of publication, type of publication, area of the SLHS, place of publication and/or event. 40 articles were found in national and international journals, from 1999 to 2017. In relation to publications in books, one book about the subject was published in 2009 and eight chapters of books were published. In the monograph format, 21 studies were carried out, there are 13 dissertations and eight thesis. A total of 151 abstracts were published in annals of scientific events, from 2001 to 2017 and 63 lectures were conducted by SLP.

Conclusion:

The inclusion of Brazilian SLP in the area of sleep disorders has been supported by scientific publications in the format of articles in national and international journals, monographs, thesis, dissertations, books and publications in event annals.

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).