ABSTRACT
Pediatric obstructive sleep apnea syndrome (OSAS) has a multifactorial origin. For the child with no dysmorphic disorders or comorbidities, its main etiology is pharyngeal soft tissue hypertrophy, a dimensional reduction of the facial skeletal frame restricting the airway, an anomaly of muscular tone, or a combination of these factors. Consequently, proper diagnosis and treatment planning for these children can require several medical specialties, according to the complexity, severity, and persistence of OSAS: ear-nose-throat specialists (ENT), pneumologists/allergologists, dentofacial orthopedists/orthodontists, and physical therapists/speech therapists. A workshop was organized so as to establish the treatment strategy for these young patients, the majority of whom cannot access multidisciplinary teams (as very few exist in France), and to create guidelines for specialists in the field. The workshop comprised an orthodontist, a pediatric ENT specialist, and a physical therapist, who led a working group of about 50 physicians. They exchanged experience, discussed publications, and established decision trees about pediatric OSAS. Three main areas were studied, and conclusions are presented in this article: (1) multidisciplinary diagnosis strategy, (2) therapy according to the patient's age, and (3) treatment modality for patients combining adenotonsillar hypertrophy and maxillary transverse deficiency.
Subject(s)
Sleep Apnea, Obstructive/therapy , Adenoidectomy , Child , Humans , Mandibular Advancement , Palatal Expansion Technique , Respiratory Therapy , TonsillectomyABSTRACT
BACKGROUND: The aim of this study was to measure forces created by progressive mandibular advancement with an oral device, during natural sleep, in a sample of adult patients with obstructive sleep apnea syndrome (OSAS). METHODS: A pressure transducer system was placed on the acrylic arms of a two-piece oral appliance (Herbst type) used by nine moderate to severe OSAS patients, in addition to all captors routinely used for polysomnography. Strains on the left and right sides were collected, during stable sleep stages without arousal, for each step of 1 mm advancement. RESULTS: The mean force in this sample was 1.18 N/mm and showed an almost linear evolution. Measurements showed intra- and inter-individual variability. CONCLUSION: The force values recorded in this study may explain the occlusal and skeletal side effects associated with long-term use of these oral appliances. They illustrate the influence of the extent of mandibular advancement, and indicate a possible dose-dependent effect.
Subject(s)
Biomechanical Phenomena , Mandibular Advancement/instrumentation , Occlusal Splints , Polysomnography , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/therapy , Adult , Arousal/physiology , Bite Force , Female , Humans , Male , Middle Aged , Orthodontic Appliance Design , Pilot Projects , Tooth Movement TechniquesSubject(s)
Mandibular Advancement/instrumentation , Sleep Apnea, Obstructive/therapy , Blood Pressure/physiology , Cephalometry , Continuous Positive Airway Pressure , Facial Bones/pathology , Facial Pain/etiology , Follow-Up Studies , Forecasting , Humans , Jaw Relation Record , Malocclusion/etiology , Mandibular Advancement/adverse effects , Oxygen/blood , Patient Preference , Periodontal Diseases/etiology , Polysomnography , Quality of Life , Respiration , Sleep Deprivation/prevention & control , Sleep Stages/physiology , Temporomandibular Joint Disorders/etiology , Tooth Diseases/etiology , Treatment OutcomeSubject(s)
Orthodontics, Corrective , Palatal Expansion Technique , Sleep Apnea, Obstructive/therapy , Child , Continuous Positive Airway Pressure , Craniofacial Abnormalities/complications , Craniofacial Abnormalities/diagnosis , Craniofacial Abnormalities/therapy , Humans , Polysomnography , Risk Factors , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/etiologyABSTRACT
The therapeutic strategy of obstructive sleep apnea syndrome (OSAS) is dependent on the illness severity, which is influenced by several factors as the presence of comorbidities (particularly cardiovascular comorbidities), the importance of diurnal drowsiness and the number of abnormal respiratory events. Whereas the treatment is most often palliative and uncomfortable, its success is closely dependent on its compliance. The way of starting the treatment of OSAS is therefore an essential topic, which will condition its long-term acceptance.
