A cefalometria é um importante preditor de distúrbios respiratórios do sono em crianças

Abstract

Cephalometry is an important predictor of sleep-related breathing disorders in childrenSleep-related breathing disorders (SBD) have been studied and treated for a long time in adults, but little attention has been given to children, for whom SBD may be as serious as for adults. Parents, guardians and healthcare personnel should pay close attention to these problems, which may be treated during childhood. Their effects on everyday life, such as hyperactivity and poor school achievement, may have a severe impact on the development of an individual and may clearly affect health.The relevance of this problem has motivated authors to evaluate the cephalometric characteristics of children with SBD. 1 Cephalometry is an important facial morphometry tool available practically all over the world. This study sample included 70 children (34 boys; mean age = 7.3±1.72 years) who usually snored and had symptoms of sleep-related obstructive breathing disorders for over 6 months. Nocturnal polysomnography was used to divide children into 3 groups: 26 children with a diagnosis of obstructive sleep apnea (OSA); 17 with signs of upper airway resistance syndrome (UARS), and 27 snorers. The control group had 70 children with no breathing obstructions paired for age and sex. Lateral head radiographs were obtained, and cephalograms were traced and measured.Children with SBD had a shorter mandible (P = 0.001) and a greater inclination in relation to the palatal plane (P = 0.01). Anterior face height (P = 0.01) and lower face height (P = 0.05) were greater than in control children. Their soft palate was longer (P = 0.018) and thicker (P = 0.002). Airways had a smaller diameter in the nasopharyngeal region, but the oropharynx had a greater diameter at the base of the tongue (P = 0.01). The hyoid bone was placed at a more inferior position (P < 0.01), and craniospinal angles were greater than those found in the control group, in which children had no breathing obstruction.When divided in subgroups according to disease severity, children with OSA had significant differences from children in the control group, particularly for the oropharyngeal variables. Children with UARS and snoring also had differences from the control groups, but subgroups with obstruction were not reliably distinguished from each other by cephalometric measures. Logistic regression revealed that UARS and OSA were associated with a decrease in pharyngeal diameter in the adenoid and uvula tip regions, an increase in its diameter in the region of the base of the tongue, and a thick soft palate. In addition, their maxilla had a more anterior position in relation to the cranial base. This is an important study because it shows that cephalometry may be an important predictor of SBD in children. Special attention should be given to the pharyngeal measures. Children with SBD should undergo systematic orthodontic evaluations because of the effects of OSA on the development of craniofacial bones. The orthodontist is the specialist with the best knowledge of the diagnostic tools ...