open access
메뉴ISSN : 0376-4672
Pediatric sleep-disordered breathing(SDB) is a common sleep disorder in children caused by obstruction of upper air way during sleep. It is often unrecognized early in life and causes various complications, including abnormal craniofacial growth and oral muscle dysfunctions. Dentist can play a significant role in managing SDB by early screening SDB risk factors and timely referring for diagnosis. SDB risk factors can be easily screened in dental office through medical history, sleep history, physical factors, sleep questionnaire, and cephalometric x-ray. In case of abnormal craniofacial development, rapid maxillary expansion, oral appliances, and myofunctional therapy can be used to reduce SDB symptoms and restore normal craniofacial development and muscular tones. Understanding continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB is important in managing pediatric SDB. The ultimate goal of pediatric SDB treatment is to change mouth breathing to nasal breathing, and a multidisciplinary approach in medicine and dentistry is necessary
1. Huang YS, Paiva T, Hsu JF, Kuo MC, Guilleminault C. Sleep and breathing in premature infants at 6 months post-natal age. Bmc Pediatrics 2014;14:1-6. https://doi.org/10.1186/s12887-014-0303-6.
2. Gipson K, Lu M, Kinane TB. Sleep-disordered breathing in children. Pediatr Rev 2019;40:3-13. https://doi.org/10.1542/pir.2018-0142.
3. Oh JI, Lee SH. Obstructive sleep apnea syndrome in children. Hanyang Med Rev 2013;33:246-252. https://doi.org/10.7599/hmr.2013.33.4.246.
4. Katyal V, Pamula Y, Daynes CN, Martin J, Dreyer CW, Kennedy D, et al. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2013;144:860-871. https://doi.org/10.1016/j.ajodo.2013.08.015.
5. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130:576-584. https://doi.org/10.1542/peds.2012-1671.
6. Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2016;47:69-94. https://doi.org/10.1183/13993003.00385-2015.
7. Shin C. Sleep-disordered breathing in children. Sleep Med Psychophysiol 2003;10:88-92.
8. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130:e714-e755. https://doi.org/10.1542/peds.2012-1672.
9. Okuji D, Healy E, Wu Y. Opportunity for interprofessional collaboration:screening for pediatric sleep-disordered breathing by dentists. Pediatric Dent 2020;42:436-440.
10. Guilleminault C, Huang YS. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Med Rev 2018;40:203-214. https://doi.org/10.1016/j.smrv.2017.06.008.
11. Huang YS, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol 2013;3:184. https://doi.org/10.3389/fneur.2012.00184.
12. Guilleminault C, Akhtar F. Pediatric sleep-disordered breathing:New evidence on its development. Sleep Med Rev 2015;24:46-56. https://doi.org/10.1016/j.smrv.2014.11.008.
13. Stauffer J, Okuji D, Lichty IG, Bhattacharjee R, Whyte F, Miller D, et al. A review of pediatric obstructive sleep apnea and the role of the dentist. J Dent Sleep Med 2018;5:111-130. http://dx.doi.org/10.15331/jdsm.7046.
14. Heit T, Tablizo BJ, Salud M, Mo F, Kang M, Tablizo MA, et al. Craniofacial sleep medicine: The important role of dental providers in detecting and treating sleep disordered breathing in children. Children 2022;9:1057. https://doi.org/10.3390/children9071057.
15. Choi JH, Kim EJ, Lee SH. Obstructive sleep apnea syndrome:A child is not just a small adult. Ann Otol Rhinol Laryngol 2010;119:656-661.
16. Sateia MJ. International classification of sleep disorders. Chest 2014;146(5):1387-1394. https://doi.org/10.1378/chest.14-0970.
17. Ngiam J, Cistulli PA. Dental treatment for paediatric obstructive sleep apnea. Paediatr Respir Rev 2015;16:174-181. https://doi.org/10.1016/j.prrv.2014.11.002.
18. Huang YS, Hsu SC, Guilleminault C, Chuang LC. Myofunctional therapy: Role in pediatric OSA. Sleep Med Clin 2019;14:135-142. https://doi.org/10.1016/j.jsmc.2018.10.004.
19. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children:A multicenter retrospective study. Am J Respir Crit Care Med 2010;182:676-683. https://doi.org/10.1164/rccm.200912-1930OC.
20. Guilleminault C, Huang YS, Glamann C, Li K, Chan A. Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg 2007;136:169-175. https://doi.org/10.1016/j.otohns.2006.09.021.
21. Li KK, Riley RW, Guilleminault C. An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia. Chest 2000;117:916-918. https://doi.org/10.1378/chest.117.3.916.
22. Behrents RG, Shelgikar AV, Conley RS, Flores-Mir C, Hans M, Lebvine M, et al. Obstructive sleep apnea and orthodontics:an American Association of Orthodontists White Paper. Am J Orthod Dentofacial Orthop 2019;156:13-28. https://doi.org/10.1016/j.ajodo.2019.04.009.
23. American Academy of Pediatric Dentistry. Policy on obstructive sleep apnea (OSA). The Reference Manual of Pediatric Dentistry;American Academy of Pediatric Dentistry: Chicago, IL, USA, 2021;123-126.
24. Pirila-Parkkinen K, Pirttiniemi P, Nieminen P, Tolonen U, Pelttari U, Lopponen H. Dental arch morphology in children with sleepdisordered breathing. Eur J Orthod 2009;31:160-167. https://doi.org/10.1093/ejo/cjn061.
25. Li AM, Au CT, Wing YK, et al. Blood pressure is elevated in children with primary snoring. J Pediatr 2009;155:362-368. https://doi.org/10.1016/j.jpeds.2009.03.041.
26. Manfredini D, Guarda-Nardini L, Marchese-Ragona R, Lobbezoo F. Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion. Sleep Breath 2015;19:1459-1465. https://doi.org/10.1007/s11325-015-1163-5.
27. Galeotti A, Festa P, Viarani V, Pavone M, Sitzia E, Piga S, et al. Correlation between cephalometric variables and obstructive sleep apnoea severity in children. Eur J Paediatr Dent 2019;20:43-47. https://doi.org/10.23804/ejpd.2019.20.01.09.
28. Fiores-Mir C, Korayem M, Major PW. Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome. J Am Dent Assoc 2013;144:269-277. https://doi.org/10.14219/jada.archive.2013.0113.
29. Friedman M, Hamilton C, Samuelson CG, Lundgren ME, Pott T. Diagnostic value of the friedman tongue position and mallampati classification for obstructive sleep apnea. Otolaryngol Head Neck Surg 2013;148:540-547. https://doi.org/10.1177/0194599812473413.
30. Guilleminault C, Huseni S, Lo L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Res 2016;2:00043-2016-43-2016. https://doi.org/10.1183/23120541.00043-2016.
31. Guilleminault C, Abad VC, Chiu HY, Peters B, Quo S. Missing teeth and pediatric obstructive sleep apnea. Sleep Breath 2016;20:561-568. https://doi.org/10.1007/s11325-015-1238-3.
32. Kang EK. Pediatric sleep questionnaires for screening of obstructive sleep apnea syndrome. Allergy Asthma Respir Dis 2019;7:122-128. https://doi.org/10.4168/aard.2019.7.3.122.
33. Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire_validity and reliability of scales for sleep disordered breathing, snoring, sleepiness, and behavioral problems. Sleep medicine 2000;1:21-32. https://doi.org/10.1016/S1389-9457(99)00009-X.
34. Villa MP, Paolino MC, Castaldo R, Vanacore N, Rizzoli A, Miano S, et al. Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing. Eur Respir J 2013;41:1355-1361. https://doi.org/10.1183/09031936.00215411.
35. Mylona AM, Rapti G, Vavougios G, Lachanas VA, Liakos P, Skoulakis C, et al. Accuracy of the sleep clinical record for the diagnosis of pediatric moderate-to-severe obstructive sleep apnea syndrome. Sleep Breath 2022;26:763-769. https://doi.org/10.1007/s11325-021-02471-4.
36. Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2013;143:20-30. https://doi.org/10.1016/j.ajodo.2012.08.021.
37. Caprioglio A, Meneghel M, Fastuca R, Zecca PA, Nucera R, Nosetti L. Rapid maxillary expansion in growing patients: correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol 2014;78:23-27. https://doi.org/10.1016/j.ijporl.2013.10.011.
38. Camacho M, Chang ET, Song SA, Abdullatif J, Zaghi S, Pirelli P, et al. Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2017;127:1712-1719. https://doi.org/10.1002/lary.26352.
39. Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year followup. Sleep Med 2015;16:933-935. https://doi.org/10.1016/j.sleep.2015.04.012.
40. Carvalho FR, Lentini-Oliveira DA, Prado LB, Prado GF, Carvalho LB. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2016;10:CD005520. https://doi.org/10.1002/14651858.CD005520.pub3.
41. Villa MP, Bernkopf E, Pagani J, Broia V, Montesano M, Ronchetti R. 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 2002;165:123-127. https://doi.org/10.1164/ajrccm.165.1.2011031.
42. Zhang C, He H, Ngan P. Effects of twin block appliance on obstructive sleep apnea in children: a preliminary study. Sleep Breath 2013;17:1309-1314. https://doi.org/10.1007/s11325-013-0840-5.
43. Yanyan M, Min Y, Xuemei G. Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis. Sleep Med 2019;60:145-151. https://doi.org/10.1016/j.sleep.2018.12.022.
44. Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, et al. Myofunctional therapy to treat obstructive sleep apnea:a systematic review and meta-analysis. Sleep 2015;38:669-675. https://doi.org/10.5665/sleep.4652.
45. Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2009;179:962-966. https://doi.org/10.1164/rccm.200806-981OC.
46. Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath 2017;21:1025-1032. https://doi.org/10.1007/s11325-017-1489-2.
47. Bandyopadhyay A, Kaneshiro K, Camacho M. Effect of myofunctional therapy on children with obstructive sleep apnea:a meta-analysis. Sleep Med 2020;75:210-217. https://doi.org/10.1016/j.sleep.2020.08.003.
48. Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, et al. Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep Breath 2015;19:281-289. https://doi.org/10.1007/s11325-014-1011-z.
49. Guilleminault C, Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH. Critical role of myofascial reeducation in pediatric sleepdisordered breathing. Sleep Med 2013;14:518-525. https://doi.org/10.1016/j.sleep.2013.01.013.
50. Chuang LC, Lian YC, Hervy-Auboiron M, Guilleminault C, Huang YS. Passive myofunctional therapy applied on children with obstructive sleep apnea: A 6-month follow-up. J Formos Med Assoc 2017;116:536-541. https://doi.org/10.1016/j.jfma.2016.08.002.
51. Mitchell RB, Garetz S, Moore RH, Rosen CL, Marcus CL, Katz ES, et al. The use of clinical parameters to predict obstructive sleep apnea syndrome severity in children: the Childhood Adenotonsillectomy (CHAT) study randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2015;141:130-136. https://doi.org/10.1001/jamaoto.2014.3049.
52. Kirk V, Baughn J, D'Andrea L, Friedman N, Galion A, Garetz S, et al. American academy of sleep medicine position paper for the use of a home sleep apnea test for the diagnosis of OSA in children. J Clin Sleep Med 2017;13:1199-1203. https://doi.org/10.5664/jcsm.6772.
53. Moeller JL, Paskay LC, Gelb ML. Myofunctional therapy:A novel treatment of pediatric sleep-disordered breathing. Sleep Med Clin 2014;9:235-243. https://doi.org/10.1016/j.jsmc.2014.03.002.
54. Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AG. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2015;10:CD011165. https://doi.org/10.1002/14651858.CD011165.pub2.