Pediatric sleep-disordered breathing in the orthodontic population: Prevalence of positive risk and associations.

INTRODUCTION: Pediatric sleep-disordered breathing (SDB) describes a spectrum of disease ranging from snoring to upper airway resistance syndrome and obstructive sleep apnea (OSA). Anatomical features assessed during orthodontic exams are often associated with symptoms of SDB in children. Hence, we need to determine the prevalence of positive risk for SDB in the pediatric orthodontic population compared with a general pediatric population and understand comorbidities associated with SDB risk among orthodontic patients. METHODS: Responses from Pediatric Sleep Questionnaires were collected from 390 patients between the ages of 5 and 16 years, seeking orthodontic treatment. Prevalence of overall SDB risk, habitual snoring, and sleepiness were determined in the orthodontic population and compared with those previously reported by identical methods in the general pediatric population. Additional health history information was used to assess comorbidities associated with SDB risk in 130 of the patients. RESULTS: At 10.8%, the prevalence of positive SDB risk was found to be significantly higher in the general pediatric orthodontic population than in a healthy pediatric population (5%). The prevalence of snoring and sleepiness in the orthodontic population was 13.3% and 17.9%, respectively. Among the comorbidities, nocturnal enuresis (13.6%), overweight (18.2%), and attention deficit hyperactivity disorder (31.8%) had a higher prevalence in orthodontic patients with higher SDB risk (P < 0.05). CONCLUSIONS: There is a higher pediatric SDB risk prevalence in the orthodontic population compared with a healthy pediatric population. Orthodontic practitioners should make SDB screening a routine part of their clinical practice.

Additional appointments and discomfort associated with compliance-free fixed Class II corrector treatment: a systematic review.

OBJECTIVE: A critical analysis of the literature to determine the prevalence and type of emergency/additional appointments, and discomfort levels associated with fixed Class II correctors. METHODS: Studies examining patient's sources of discomfort or emergency appointments associated with compliance-free Class II correctors were included. Comprehensive searches up to July 2018 were conducted using the following databases: MEDLINE (OvidSP), PubMed, Web of Science, and Embase. A partial grey literature search was taken using Google Scholar and OpenGrey. Two reviewers independently performed the selection process and risk of bias assessment. The Newcastle-Ottawa Scale for cross-sectional studies were used. A summary of the overall strength of evidence was presented using 'Grading of Recommendations, Assessment, Development and Evaluation' (GRADE) tool. Included studies were evaluated according to their design, study quality, consistency, and directness. RESULTS: The selected studies were published between 2001 and 2018, and the number of patients per studied group ranged from 8 to 182. One thousand five hundred forty-two patients were evaluated in total. The patients' mean age at start of treatment ranged from 10 to 16.9 years and the fixed Class II corrector treatment duration ranged from 4 to 12 months. The included studies in this systematic review were too clinically heterogeneous (different appliances, different data recollection processes) to justify a meta-analysis. LIMITATIONS: This review was not previously registered. A low level of evidence was observed among the two randomized trials, the 10 cohorts and three cross-sectional studies identified. CONCLUSIONS: The main source of discomfort from Forsus-type appliances appears to be soreness in the cheeks (low level of evidence with a weak recommendation strength). Most evaluated patients treated with a Herbst appliance, regardless of design, will experience complications (fractures and/or dislodging) requiring emergency appointments (low level of evidence with a weak recommendation strength). REGISTRATION: The review protocol was not registered.

Cranial base length in pediatric populations with sleep disordered breathing: A systematic review.

The aim of this study was to review the existing literature on the association between cranial base length (CBL) and sleep disordered breathing (SDB) in children. Searches were carried out using Ovid MEDLINE, EMBASE, and Science Citation Index. Modified NIH (National Institute of Health) quality assessment tool was used to assess risk of bias. Grading of recommendations, assessment, development and evaluation (GRADE) was used to summarize the quality of evidence. Six articles met the inclusion criteria. Two studies (n = 57) showed shorter CBL in children with obstructive sleep apnea (OSA). One study (n = 29) showed shorter CBL in children that were habitual snorers. Another study (n = 15) looking at OSA-affected vs. healthy children and one (n = 56) looking at correlation of CBL with OSA severity in children, did not report a significant association/correlation. One study (n = 7) showed a longer CBL in OSA affected boys. All studies had high risks of bias and ranged from low to very low in quality. Although studies with slightly lower risks of bias may indicate shorter CBL in children with SDB, neither an association nor a lack thereof between CBL and pediatric SDB can be supported or refuted due to the low to very low quality of included studies.