Craniofacial Sleep Medicine: The Important Role of Dental Providers in Detecting and Treating Sleep Disordered Breathing in Children

Abstract

Obstructive sleep apnea (OSA) is a clinical disorder within the spectrum of sleep-related breathing disorders (SRDB) which is used to describe abnormal breathing during sleep resulting in gas exchange abnormalities and/or sleep disruption. OSA is a highly prevalent disorder with associated sequelae across multiple physical domains, overlapping with other chronic diseases, affecting development in children as well as increased health care utilization. More precise and personalized approaches are required to treat the complex constellation of symptoms with its associated comorbidities since not all children are cured by surgery (removal of the adenoids and tonsils). Given that dentists manage the teeth throughout the lifespan and have an important understanding of the anatomy and physiology involved with the airway from a dental perspective, it seems reasonable that better understanding and management from their field will give the opportunity to provide better integrated and optimized outcomes for children affected by OSA. With the emergence of therapies such as mandibular advancement devices and maxillary expansion, etc., dentists can be involved in providing care for OSA along with sleep medicine doctors. Furthermore, the evolving role of myofunctional therapy may also be indicated as adjunctive therapy in the management of children with OSA. The objective of this article is to discuss the important role of dentists and the collaborative approach between dentists, allied dental professionals such as myofunctional therapists, and sleep medicine specialists for identifying and managing children with OSA. Prevention and anticipatory guidance will also be addressed.

Importância Do Cirurgião-Dentista No Diagnóstico Da Apneia Obstrutiva Do Sono

“…Estudos revelam que os principais sinais e sintomas relatados pelos pacientes são a presença de ronco, sonolência diurna excessiva, má qualidade do sono e vários problemas de saúde cardiometabólicos. (DANTAS, et al 2022;Heit, et al, 2022;) Nessa perspectiva, o Cirurgião-Dentista tem grande importância na realização de diversos diagnósticos, visto que dentro do seu estudo/formação e prática clínica está incluso a obtenção de históricos médicos e odontológicos, identificação de estruturas orais anormais, bem como a detecção de doenças bucais, identificação de relações de saúde bucal e sistêmica, inclusive na identificação de sinais e sintomas de bruxismo relacionado ao sono, ronco primário e, sobretudo, no diagnóstico da apneia (SCHROEDER, GURENLIAN, 2019;ANWER et al, 2021;HEIT et al, 2022)…”

Prevalence of Obstructive Sleep Apnea in 6–9-Year-Old Children of Visnagar: A Cross-Sectional Study

“…In previous studies that employed the BEARS questionnaire to identify obstructive sleep apnea (OSA) in children, however, it was observed that while the BEARS questionnaire was effective in detecting sleep disturbances, it did not provide any information about other clinical factors that are associated with OSA [21][22][23]. On the other hand, in studies that utilized the FAIRST questionnaire to diagnose OSA in children, the authors reached the conclusion that it is a concise, validated tool that solely relies on clinical evaluation [11,24].…”

Current Concepts in Pediatric Obstructive Sleep Apnea

“…In young healthy children, the main etiology of OSA is related to adenoid and/or tonsillar hypertrophy [ 10 ]. However, other factors such as malocclusion or other causes of inflammation such as allergic rhinitis and asthma may also play a significant role [ 10 , 11 ]. Obesity is increasingly more prevalent in the pediatric population and is a significant risk factor for OSA especially in the adolescent group [ 10 ].…”

“…If the cardiopulmonary coupling can be assessed apriori, this could result in a fundamental shift in the way childhood OSA is managed and treated as the authors point out. Dr. Guillemineault and colleagues had shown that children with OSA required both rapid maxillary expansion and adenotonsillectomy for a complete cure of OSA in children with malocclusion and associated OSA symptoms [ 11 ]. Preventative care to optimize the normal development of maxillofacial skeleton and function to decrease risk of developing OSA is also discussed.…”

“…Preventative care to optimize the normal development of maxillofacial skeleton and function to decrease risk of developing OSA is also discussed. Advances in oral appliances for children continue to evolve which indicates the importance of interdisciplinary synergistic collaboration with the field of dentistry and medicine to treat OSA [ 11 ]. There is a need for increased awareness and education about pediatric OSA in both medical and dental schools [ 18 ].…”