Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral healthrelated sleep disorders that are commonly seen in dental practice. Oral Diseases (2014) 20, 236-245
Objective
Assess the frequency and potential clinical impact of periodic leg movements during sleep, with or without arousals, as recorded incidentally from children before and after adenotonsillectomy.
Methods
Children scheduled for adenotonsillectomy for any clinical indications who participated in the Washtenaw County Adenotonsillectomy Cohort II were studied at enrollment and again 6 months thereafter. Assessments included laboratory-based polysomnography, a Multiple Sleep Latency Test (MSLT), parent-completed behavioral rating scales, neuropsychological testing, and psychiatric evaluation.
Results
Participants included 144 children (81 boys) aged 3–12 years. Children generally showed mild to moderate obstructive sleep apnea (median respiratory disturbance index 4.5 [Q1=2.0, Q3=9.5]) at baseline, and 15 subjects (10%) had at least 5 periodic leg movements per hour of sleep (PLMI≥5). After surgery, 21 (15%) of n=137 subjects who had follow-up studies showed PLMI≥5 (p=.0067). Improvements were noted after surgery in the respiratory disturbance index; insomnia symptoms; sleepiness symptoms; mean sleep latencies; hyperactive behavior; memory, learning, attention, and executive functioning on NEPSY assessments; and frequency of Attention-Deficit/Hyperactivity Disorder (DSM-IV criteria). However, PLMI≥5 failed to show associations with worse morbidity in these domains at baseline or follow-up. New appearance of PLMI≥5 after surgery failed to predict worsening of these morbidities (all p>.05), with only one exception (NEPSY) where the magnitude of association was nonetheless negligible. Similar findings emerged for periodic leg movements with arousals (PLMAI≥1).
Conclusion
Periodic leg movements during sleep, with and without arousals, become more common after adenotonsillectomy in children. However, results in this setting did not suggest substantial clinical impact.
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