SDB involves obstruction of the upper airway, which may be partially due to craniofacial structure involvement. The goal of surgical treatment should be aimed at enlarging the airway, and not be solely focused on treating inflammation or infection of the lymphoid tissues. This goal may not be met in some patients, thus potentially contributing to residual problems seen after surgery. The possibility of further treatment, including collaboration with orthodontists to improve the craniofacial risk factors, should be considered in children with residual problems.

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Objective: This study aimed at assessing the relationship between facial morphological patterns (I, II, III, Long Face and Short Face) as well as facial types (brachyfacial, mesofacial and dolichofacial) and obstructive sleep apnea (OSA) in patients attending a center specialized in sleep disorders. Methods: Frontal, lateral and smile photographs of 252 patients (157 men and 95 women), randomly selected from a polysomnography clinic, with mean age of 40.62 years, were evaluated. In order to obtain diagnosis of facial morphology, the sample was sent to three professors of Orthodontics trained to classify patients' face according to five patterns, as follows: 1) Pattern I; 2) Pattern II; 3) Pattern III; 4) Long facial pattern; 5) Short facial pattern. Intraexaminer agreement was assessed by means of Kappa index. The professors ranked patients' facial type based on a facial index that considers the proportion between facial width and height. Results: The multiple linear regression model evinced that, when compared to Pattern I, Pattern II had the apnea and hypopnea index (AHI) worsened in 6.98 episodes. However, when Pattern II was compared to Pattern III patients, the index for the latter was 11.45 episodes lower. As for the facial type, brachyfacial patients had a mean AHI of 22.34, while dolichofacial patients had a significantly statistical lower index of 10.52. Conclusion: Patients' facial morphology influences OSA. Pattern II and brachyfacial patients had greater AHI, while Pattern III patients showed a lower index.

This study's aims were to determine: (1) prevalence of periodic leg movements (PLMs) in walking prepubertal children consulting a sleep clinic for any sleep disorder; (2) associations between PLMs and other sleep and medical disorders; and (3) the response of other sleep disorders to treatment with the dopamine agonist pramipexol. Clinical evaluation and polysomnography were carried out for a period of 12 months on 252 consecutively seen, prepubertal children with sleep disorders (156 males, 96 females; aged 15mo to 11y, mean 7y 1mo, SD3y 10mo). Sleep disorders unrelated to PLMs were treated, and six children received pramipexol for PLMs. Follow-up included clinical evaluation and polysomnography. Twenty-three per cent of children were diagnosed with PLMs on the basis of polysomnography. The presence of PLMs had usually been unrecognized clinically. The only clinical symptom that could be related to periodic limb movement disorder was a report of leg pains at morning awakening. Only two of 58 children had PLMs without other clinical or polysomnographic findings. Comorbidity seen with PLMs included neuropsychiatric syndromes (n=20), isolated sleep disordered breathing (SDB; n=29), and several other comorbid conditions (n=7). Seven of 11 children seen with attention-deficit-hyperactivity disorder also had PLMs. Surgery for SDB was associated with subsequent cessation of PLMs in 15 of 29 children. Five out of six children with PLMs who received pramipexol were able to tolerate the drug and experienced a complete disappearance of their PLMs. Presence of chronic fatigue, sleepiness, disrupted nocturnal sleep, and difficulties in falling asleep should lead to a systematic search for PLMs that is independent of associated syndromes. Isolated treatment of SDB might help eliminate some, but not all, PLMs.