Combined Surgical and Orthodontic Treatments in Children with OSA: A Systematic Review

Templier, Laura; Rossi, Cecilia; Miguez, Manuel; Pérez, Javier de la Cruz; Curto, Adrián; Albaladejo, Alberto; Vich, Manuel Lagravere

doi:10.3390/jcm9082387

Cited by 20 publications

(16 citation statements)

References 49 publications

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“…Templier et al evaluated the evidence for the efficiency of AT and orthodontic treatment in a systematic review, and stated that AT-combined orthodontic treatments (RME and/or MAD) were more effective together than separately to cure OSA in paediatric patients. 29 …”

Section: Discussionmentioning

confidence: 99%

“…Systematic reviews and meta-analyses about OSA treatments have been reported, but the comparison of the different treatments is very limited. Templier et al evaluated the evidence for the efficiency of AT and orthodontic treatment in a systematic review, and stated that AT-combined orthodontic treatments (RME and/or MAD) were more effective together than separately to cure OSA in paediatric patients 29…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of orthodontic treatment versus adenotonsillectomy in children with moderate obstructive sleep apnoea and mandibular retrognathia: study design and protocol for a non-inferiority randomised controlled trial

et al. 2022

BMJ Open

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IntroductionOrthodontic treatment and adenotonsillectomy (AT) are both conventional treatments for paediatric obstructive sleep apnoea (OSA). Each approach has distinct treatment advantages; however, there is currently a lack of solid evidence to support their efficacy comparison. We hypothesise that the objective effect of orthodontic treatment is not inferior to AT in children with moderate OSA and mandibular retrognathia, but orthodontic treatment has the advantage of promoting dentofacial growth.Methods and analysisThis is a randomised, open-label, parallel-group, active controlled trial that will study the efficacy of orthodontic treatment versus AT in children with moderate OSA accompanied by tonsillar adenoid hypertrophy and mandibular retrognathia. A total of 98 patients will be enrolled and randomised in a 2:1 ratio to either orthodontic treatment or AT group. Participants will be recruited at Shanghai Stomatological Hospital, Shanghai Children’s Hospital of Shanghai Jiaotong University and Children’s Hospital of Fudan University, which are all located in Shanghai, China. The primary endpoint is the per cent change in the obstructive apnoea–hypopnoea index from baseline (month 0) to the primary endpoint (month 7), and the mean reduction in A point, nasion and B point angle on cephalometric measurements by lateral X-ray films. Important secondary efficacy endpoints include sleep duration with oxygen saturation below 90% according to polysomnography and subjective symptoms (assessed by the OSA-20 questionnaire), etc. Safety endpoints will also be evaluated.Ethics and disseminationThe study was approved by the ethics committees of Shanghai Stomatological Hospital (approval no. (2021)002), Shanghai Children’s Hospital of Shanghai Jiaotong University (approval no. 2021R046-F01) and Children’s Hospital of Fudan University (approval no. (2021)136). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals.Trial registration numberChiCTR2000037288.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of orthodontic treatment versus adenotonsillectomy in children with moderate obstructive sleep apnoea and mandibular retrognathia: study design and protocol for a non-inferiority randomised controlled trial

et al. 2022

BMJ Open

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“…A combination of AT and dental interventions might be more effective in patients than performed separately. 128 Mandibular distraction osteogenesis is one of the maxillo-mandibular surgeries performed for children with congenital craniofacial abnormalities such as Pierre Robin sequence or Treacher Collins syndrome. 123 These interventions should be co-ordinated by a multidisciplinary team, preluded by and followed-up with sleep studies.…”

Section: Treatment Optionsmentioning

confidence: 99%

Paediatrics: how to manage obstructive sleep apnoea syndrome

Leung¹,

Cheng²,

Chan³

2021

DIC

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Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.

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“…TA together with orthodontic treatment is considered more effective together than separately for SDB in pediatric patients, however, recurrence of SDB may occur several years later. To prevent recurrence, myofunctional therapy could be recommended as a follow-up, however, more studies with good clinical evidence are required to confirm this finding [31] . The childhood adenotonsillectomy trial demonstrated improvement in PSG metrics, as well as secondary behavioral and quality of life outcomes, in both obese and non-obese children with PSGdiagnosed OSA [29] .…”

Section: Treatmentmentioning

confidence: 99%

Sleep-disordered breathing in children

Alarcon¹,

Ramírez²,

Quintero³

et al. 2021

Int. J. Appl. Dent. Sci.

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Sleep disordered breathing (SDB) leads to pathological changes that lead to increased morbidity and mortality in patients. Objective: To analyze the literature on sleep disordered breathing, its etiology, diagnosis, signs and symptoms and treatment in children. Methodology: Articles on the subject published through the PubMed, SCOPUS and Google Academic databases were analyzed, with an emphasis on the last 5 years. It was carried out with the words "Sleep-Disordered Breathing", "children" "etiology" "diagnosis" "symptoms" "treatment". Results: The etiology of SDB is associated in children with developmental anomalies, craniofacial malformations, syndromes, these lead to airway narrowing that triggers adenotonsillar hypertrophy and shortness of breath. Polysomnography is found as an effective and most used diagnostic test, however in very young children or with severe diseases additional studies are needed with a pediatric otolaryngologist, other tests are pulse oximetry or questionnaires. There are nighttime symptoms such as shortness of breath, night sweats, sleep irregularities and snoring, those present during the day are summarized as lack of performance, poor performance, moodiness, hyperactivity. Together they result in signs of malocclusion and altered facial development. Tonsillectomy or adenoidectomy is the most effective treatment in patients with SDB, this is complemented with orthodontic treatment and functional appliances improve the quality of life of patients. Conclusion:It is of great importance to diagnose and treatment SDB because it causes alterations in the development of facial growth and in the quality of life of pediatric patients.

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Combined Surgical and Orthodontic Treatments in Children with OSA: A Systematic Review

Cited by 20 publications

References 49 publications

Efficacy of orthodontic treatment versus adenotonsillectomy in children with moderate obstructive sleep apnoea and mandibular retrognathia: study design and protocol for a non-inferiority randomised controlled trial

Efficacy of orthodontic treatment versus adenotonsillectomy in children with moderate obstructive sleep apnoea and mandibular retrognathia: study design and protocol for a non-inferiority randomised controlled trial

Paediatrics: how to manage obstructive sleep apnoea syndrome

Sleep-disordered breathing in children

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