Expansión maxilar rápida para pacientes pediátricos con síndrome de apnea obstructiva del sueño / Rapid maxillary expansion in pediatric patients with obstructive sleep apnea syndrome

RESUMEN: Introducción: El síndrome de apnea obstructiva del sueño (SAOS) es un trastorno respiratorio del sueño frecuente, caracterizado por episodios de obstrucción parcial o total de las vías respiratorias durante el sueño. La expansión maxilar rápida se ha propuesto como un posible tratamiento de esta patología en niños ya que su uso aumentaría el volumen de la vía aérea superior. Sin embargo, su uso para el tratamiento de apnea obstructiva del sueño es controvertido. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos seis revisiones sistemáticas que en conjunto incluyeron 23 estudios primarios. Concluimos que no es posible establecer con claridad el efecto del uso de la expansión maxilar sobre el índice de apnea-hipoapnea, eficiencia y tiempo del sueño, y microdespertares por causa respiratoria, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja. No se encontraron estudios que evaluaran los efectos adversos ni la somnolencia diurna de los pacientes sometidos a expansión maxilar.

ABSTRACT: Introduction: Obstructive sleep apnea (OSA) is a frequent sleep disorder characterized by recurrent episodes of complete or partial obstruction of the upper airway during sleep. Since rapid maxillary expansion increases the volume of the upper airway, it has been proposed as a treatment option for OSA in children. However, its use is controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified six systematic reviews including 23 studies overall. We are uncertain whether rapid maxillary expansion reduces apnea-hypopnea index and micro-awakenings, or improves sleep efficiency and total sleep time as the certainty of the evidence has been assessed as very low. No studies were found that looked at adverse effects or daytime sleepiness.

The Prevalence and the Characteristics of Supernumerary Teeth of Children and Young Adolescents from North-Western Region of Turkey.

Aim: The objective of the following research is to study the prevalence by evaluating a large group of children and young adolescent patients from the north-western region of Turkey and investigate the characteristics of supernumerary teeth. Methodology: This descriptive and retrospective study was performed on 6535 non-syndromic children and adolescent patients (4077 females and 2458 males) ranging in age from 5 to 18 years old. The characteristics of supernumerary teeth were noted and diagnosed during the clinical and radiographic examination. For each patient we recorded the demographic variables including age and gender. During statistical analysis Chi-squared test was used to determine potential differences in the distribution of supernumerary teeth when stratified by gender. p value of less than .05 was considered statistically significant. Results: 177 supernumerary teeth were detected in 141 patients (2.2%). 58 patients were females and 83 patients were males with a 1.4:1 male/female ratio (p<.001) among them. In 78.0% (n=110) of patients, one supernumerary tooth was observed. A total of 177 supernumerary teeth were observed, of which 84.2% (n=149) were located in the maxillary arch, while 15.8% (n=28) were determined in the mandible. 78 teeth (44.1%) of all supernumerary teeth were found in the maxilla midline (mesiodens). Regarding their status within the arch, 65 supernumerary teeth (36.7%) had erupted. 100(56.5%) supernumerary teeth did not cause any complications whereas 77(43.5%) teeth caused a complication. 119 supernumerary teeth (67.2%) were extracted and most of them were the complication source, however periodical observation was chosen as a treatment option for 58 teeth (32.8%). Conclusion: The frequency of supernumerary teeth was 2.2% in the following research and we found out that supernumerary teeth are not a very rare case among children and young adolescents and clinicians should take measures and examine all patients carefully even at early ages.

Noninvasive ambulatory blood pressure monitoring in 22 healthy normotensive young adolescents

BACKGROUND: Ambulatory blood pressure monitoring is widely available in clinical practice. To evaluate the pattern of normal 24 hour variation of blood pressure and the problems in analysis of data which was obtained with use of automatic blood pressure recorder, 24 hour ambulatory blood pressure was measured. METHODS: Ambulatory blood pressure was recorded for 24 hours with automatic blood pressure monitor in 22 normotensive young adolescents. RESULTS: 1) Average 24-hour BP was 109mmHg in systolic(115+/-30 for male, 102+/-30 for female), 66mmHg in diastolic(69+/-18 for male, 63+/-19 for female) and pulse rate was 72 beats per minute(70+/-23 for male, 75+/-26 for female). 2) Data obtained from ambulatory blood pressure monitor should be analyzed after deletion of unacceptable data with use of conventional criteria. Blood pressure increase which is not accompanied by increase in pulse rate increase can be used as another criteria to rule out unacceptable blood pressure data. 3) Blood pressure was low from mid-night to 6 A.M. and began to rise slowly till mid-day and then maintained steadily through the remainder of the day. And 24 hour variation of blood pressure was more adequately assessed after application of Fourier analysis. CONCLUSIONS: These results suggest that certain deletion criteria was inevitable during analysis of the data which were obtained from ambulatory blood pressure recorder and Fourier analysis can be used as valuable smoothing technique to assess the 24-hour blood pressure profiles.