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Sleep-disordered breathing in orthodontic practice

Prevalence of snoring in children and morphological findings

Schlafbezogene Atmungsstörungen in der kieferorthopädischen Praxis

Prävalenz von Schnarchen bei Kindern und morphologische Besonderheiten

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this work was to evaluate the prevalence of snoring and its correlation with cranial and upper airway morphology in young individuals with orthodontic treatment need.

Patients and methods

Parents of 379 children were consecutively interviewed, using eight questions from a more comprehensive questionnaire about sleep behavior. A total of 100 patients (54 girls, 46 boys, average age 11.3 years) met the inclusion criteria. Based on the parents’ interviews, the sample was divided into snorers (n = 53) and nonsnorers (n = 47). Using cephalograms obtained for initial orthodontic diagnostics, airway morphology was measured based on hyoid position and on the posterior airway space (PAS) dimensions at the maxillary, occlusal, and mandibular plane levels (PAS_NL, PAS_OCCL, PAS_ML). Mann–Whitney U testing, ANOVA, and Spearman’s rank correlation coefficient were used for statistical analysis.

Results

Snoring was reported by 53 % of parents for 63 % (n = 29) of the boys and 44 % (n = 24) of the girls. Significant morphological differences were noted between snorers and nonsnorers. PAS dimensions were significantly reduced in the snorers compared to the nonsnorers at all three anatomical levels tested, which remained statistically significant when adjusted for age and gender. No differences between the two groups emerged for hyoid position or any of the vertical cranial parameters. A significant correlation between sagittal maxillary position (SNA) and PAS_NL was noted, indicating that larger SNA values were mildly associated with larger sagittal PAS dimensions at the maxillary level.

Conclusion

This random sample of young patients with orthodontic treatment need was found to involve a high prevalence of parent-reported snoring. Characteristic features in cranial and upper airway morphology and thus differences between the snorers and nonsnorers were found.

Zusammenfassung

Zielsetzung

Ziel dieser Untersuchung war es, das Vorkommen der schlafbezogenen Atmungsstörung “Schnarchen” und damit verbundene mögliche Besonderheiten der Schädel- und Atemwegsmorphologie bei Kindern und Jugendlichen mit kieferorthopädischem Behandlungsbedarf zu evaluieren.

Material und Methoden

Insgesamt 379 Eltern von Kindern mit kieferorthopädischem Behandlungsbedarf wurden konsekutiv hinsichtlich des Schlafverhaltens ihrer Kinder befragt. Hierzu dienten 8 Fragen aus einem Fragebogen zum Schlafverhalten von Schulkindern. In die Studie wurden 100 Patienten aufgenommen (46 männlich, 54 weiblich, Durchschnittsalter 11,3 Jahre). Es erfolgte eine Stratifizierung hinsichtlich des durch die Eltern berichteten nächtlichen Schnarchens (Schnarcher n = 53; Nichtschnarcher n = 47). Analysiert wurden Fernröntgenseitenbilder (FRS), die im Rahmen einer initialen kieferorthopädischen Diagnostik angefertigt worden waren (fr-Win©, Computer-Konkret, Falkenstein, Deutschland). Zur Beurteilung der oberen Atemwege wurde der Posterior Airway Space (PAS) auf Höhe der Oberkiefergrund- (PAS_NL), der Okklusions- (PAS_OCCL) und der Unterkiefergrundebene (PAS_ML) parallel zur Frankfurter Horizontalen gemessen, ferner die Lage des Hyoids. Die Reliabilität der Messungen wurde durch den Dahlberg-Koeffizienten getestet, die kephalometrischen Werte mittels Mann–Whitney-U-Test geprüft (p = 0,05) und der Einfluss von Alter und Geschlecht auf die gemessenen Werte ermittelt (ANOVA). Darüber hinaus wurde der Zusammenhang zwischen der sagittalen Kieferrelation SNA und SNB und dem PAS_NL und dem PAS_ML mithilfe des Spearman-Rangkorrelationskoeffizienten evaluiert.

Ergebnisse

Dass ihre Kinder schnarchten, gaben 53 % der Eltern an, 63 % (n = 29) der männlichen und 44 % (n = 24) der weiblichen Kinder. Zwischen Schnarchern und Nichtschnarchern zeigten sich statistisch signifikante morphologische Unterschiede, die alters- und geschlechtsunabhängig waren. Bei Schnarchern war der PAS auf allen 3 Ebenen signifikant kleiner als bei Nichtschnarchern. Es gab weder Unterschiede hinsichtlich der Position des Hyoids noch bezüglich des vertikalen Schädelaufbaus. Eine Tendenz zur Abhängigkeit zwischen SNA und PAS_NL konnte festgestellt werden; bei einer Vergrößerung des SNA war auch der PAS auf Höhe des Oberkiefers tendenziell größer.

Schlussfolgerung

Die Häufigkeit der subjektiv berichteten schlafbezogenen Störung Schnarchen erwies sich in dieser kieferorthopädischen Zufallsstichprobe als hoch. Es fanden sich Besonderheiten in der Morphologie des Schädels und der oberen Atemwege und somit Unterschiede zwischen schnarchenden und nichtschnarchenden Patienten mit kieferorthopädischem Behandlungsbedarf.

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Authors and Affiliations

  1. Department of Orthodontics, University Hospital of Cologne, Kerpener Strasse 32, 50931, Cologne, Germany

    Isabelle Graf, Julia Neuschulz & Bert Braumann

  2. Orthodontic Practice, Essen, Germany

    Uwe Schumann

  3. Department of Operative Dentistry and Periodontology, University Hospital of Cologne, Cologne, Germany

    Karolin Höfer

  4. Oral and Maxillofacial Surgery Practice, Hennef, Germany

    Lutz Ritter

Authors
  1. Isabelle Graf
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  2. Uwe Schumann
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  3. Julia Neuschulz
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  4. Karolin Höfer
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  5. Lutz Ritter
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  6. Bert Braumann
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Correspondence to Isabelle Graf.

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Conflict of interest

Isabelle Graf, Uwe Schumann, Julia Neuschulz, Karolin Höfer, Lutz Ritter, and Bert Braumann state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included.

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Dr. Isabelle Graf.

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Graf, I., Schumann, U., Neuschulz, J. et al. Sleep-disordered breathing in orthodontic practice. J Orofac Orthop 77, 129–137 (2016). https://doi.org/10.1007/s00056-016-0017-5

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