Sleep and Breathing

, Volume 16, Issue 4, pp 971–976 | Cite as

Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome

  • Maria Pia Villa
  • Silvia Miano
  • Alessandra Rizzoli
Review
First Online:
Received:
Revised:
Accepted:

Abstract

Background

Orthodontic and craniofacial abnormalities have often been reported in pediatric sleep-disordered breathing (SDB). While the reversibility of these craniofacial abnormalities by means of adenotonsillectomy has yet to be established, orthodontic treatment based on oral appliances is considered to be a potential additional treatment for pediatric SDB.

Discussion

Oral appliances may help improve upper airway patency during sleep by enlarging the upper airway and/or by decreasing upper airway collapsibility, thereby enhancing upper airway muscle tone. Orthodontic therapy should be encouraged in pediatric OSAS, and an early approach may permanently modify nasal breathing and respiration, thereby preventing obstruction of the upper airway.

Keywords

Obstructive sleep apnea Children Rapid maxillary expander Malocclusion Apnea–hypopnea index Polysomnography 
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Notes

Conflicts of interest

All authors are disclosing any conflict of interests, any affiliation, financial agreement, or other involvement of any author with any company whose product figures prominently in the submitted manuscript, and any off-label or investigational use.

References

  1. 1.
    Arens R, Marcus CL (2004) Pathophysiology of upper airway obstruction: a developmental perspective. Sleep 27:997–1019PubMedGoogle Scholar
  2. 2.
    Guilleminault C, Li KK, Khramtsov A, Pelayo R, Martinez S (2004) Sleep disordered breathing: surgical outcomes in prepubertal children. Laryngoscope 114:132–137PubMedCrossRefGoogle Scholar
  3. 3.
    Guilleminault C, Partinen M, Praud JP, Quera-Salva MA, Powell N, Riley R (1989) Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr 114:997–999PubMedCrossRefGoogle Scholar
  4. 4.
    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 91:71–77PubMedCrossRefGoogle Scholar
  5. 5.
    Mitchell RB, Kelly J (2004) Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 68:1375–1379PubMedCrossRefGoogle Scholar
  6. 6.
    Shintani T, Asakura K, Kataura A (1996) Adenotonsillar hypertrophy and skeletal morphology of children with obstructive sleep apnea syndrome. Acta Otolaryngol 523:S222–S224Google Scholar
  7. 7.
    Tasker C, Crosby JH, Stradling JR (2002) Evidence for persistence of upper airway narrowing during sleep, 12 years after adenotonsillectomy. Arch Dis Child 86:34–37PubMedCrossRefGoogle Scholar
  8. 8.
    Agren K, Nordlander B, Linder-Aronsson S, Zettergren-Wijk L, Svanborg E (1998) Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement. Acta Otolaryngol 118:581–587PubMedCrossRefGoogle Scholar
  9. 9.
    Kulnis R, Nelson S, Strohl K, Hans M (2000) Cephalometric assessment of snoring and nonsnoring children. Chest 118:596–603PubMedCrossRefGoogle Scholar
  10. 10.
    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 59:286–291PubMedCrossRefGoogle Scholar
  11. 11.
    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 13:411–417PubMedCrossRefGoogle Scholar
  12. 12.
    Goldbart AD, Goldman JL, Veling MC, Gozal D (2005) Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 172:364–370PubMedCrossRefGoogle Scholar
  13. 13.
    Villa MP, Malagola C, Pagani J, Montesano M, Rizzoli A, Guilleminault C, Roberto R (2007) Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12 months follow-up. Sleep Med 8:128–134PubMedCrossRefGoogle Scholar
  14. 14.
    Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 9:469–477PubMedGoogle Scholar
  15. 15.
    Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RW, Darendeliler MA, Cistulli PA (2010) The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 65:726–732PubMedCrossRefGoogle Scholar
  16. 16.
    Miano S, Rizzoli A, Evangelisti M, Bruni O, Ferri R, Pagani J, Villa MP (2009) NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome. Sleep Med 10:471–478PubMedCrossRefGoogle Scholar
  17. 17.
    Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262PubMedGoogle Scholar
  18. 18.
    American Sleep Disorders Association (1995) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. Sleep 18:511–513Google Scholar
  19. 19.
    Kheirandish L, Goldbart AD, Gozal D (2006) Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 117:e61–e66PubMedCrossRefGoogle Scholar
  20. 20.
    Cartwright R, Ferguson K, Rogers R, Schmidt-Nowara W (2005) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262Google Scholar
  21. 21.
    Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer JP, American Academy of Sleep (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29:240–243PubMedGoogle Scholar
  22. 22.
    Bloch KE (2006) Alternatives to CPAP in the treatment of the obstructive sleep apnea syndrome. Swiss Med Wkly 136:261–267PubMedGoogle Scholar
  23. 23.
    Ng AT, Gotsopoulos H, Qian J, Cistulli PA (2003) Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med 168:238–241PubMedCrossRefGoogle Scholar
  24. 24.
    Lim J, Lasserson TJ, Fleetham J, Wright J (2006) Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev 25:CD004435Google Scholar
  25. 25.
    Carvalho FR, Lentini-Oliveira D, Machado MA, Prado GF, Prado LB, Saconato H (2007) Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database Syst Rev 18:CD005520Google Scholar
  26. 26.
    Pirelli P, Saponara M, Guilleminault C (2004) Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep 27:761–766PubMedGoogle Scholar
  27. 27.
    Sistema nazionale le linee guida (2008) Appropriatezza e sicurezza degli interventi di tonsillectomia e/o adenoidectomia. Documento 15Google Scholar
  28. 28.
    Monini S, Malagola C, Villa MP, Tripodi C, Tarentini S, Malagnino I, Marrone V, Lazzarino AI, Barbara M (2009) Rapid maxillary expansion for the treatment of nasal obstruction in children younger than 12 years. Arch Otolaryngol Head Neck Surg 135:22–27PubMedCrossRefGoogle Scholar
  29. 29.
    Ramires T, Maia RA, Barone JR (2008) Nasal cavity changes and the respiratory standard after maxillary expansion. Rev Bras Otorrinolaringol 74:763–769CrossRefGoogle Scholar
  30. 30.
    Cistulli PA, Palmisano RG, Poole MD (1998) Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep 21:831–835PubMedGoogle Scholar
  31. 31.
    Villa MP, Bernkopf E, Pagani J, Broia V, Montesano M, Ronchetti R (2002) Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med 165:123–127PubMedGoogle Scholar
  32. 32.
    Brouillette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C (1984) A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 105:10–14CrossRefGoogle Scholar
  33. 33.
    Villa MP, Rizzoli A, Miano S, Malagola C (2011) Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath 15:179–184PubMedCrossRefGoogle Scholar
  34. 34.
    Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, Gozal D (2010) Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 182:676–683PubMedCrossRefGoogle Scholar
  35. 35.
    Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D (2008) Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 5:274–582PubMedCrossRefGoogle Scholar
  36. 36.
    Katz ES, D’Ambrosio CM (2010) Pediatric obstructive sleep apnea syndrome. Clin Chest Med 31:221–234PubMedCrossRefGoogle Scholar
  37. 37.
    Guilleminault C, Huang YS, Glamann C, Li K, Chan A (2007) Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg 136:169–175PubMedCrossRefGoogle Scholar
  38. 38.
    Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009) Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 179:962–966PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Maria Pia Villa
    • 1
  • Silvia Miano
    • 1
  • Alessandra Rizzoli
    • 1
  1. 1.Department of Pediatrics, Sleep Disease CentreUniversity of Rome La Sapienza-Sant’Andrea HospitalRomeItaly

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