Abstract:Background
Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA.
Aim
Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta‐analysis.
Design
Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea‐hypopnea index (AHI), o… Show more
“…Going back to the ‘TAKE ACTION’ principles, the importance of orthodontic management of upper airway applies to both growing and non‐growing orthodontic patients 4,11 . In growing patients, the goals of early treatment in BOS include favourable upper airway development by accomplishing a stable tripod relationship between nasomaxillary complex and mandible relative to the cranial base 57 . The combined protocol of the horseshoe‐type maxillary expander and tongue elevator with myofunctional training is an airway‐friendly growth modification treatment for pre‐school and school age groups.…”
Temporary skeletal anchorage devices (TSADs) have been used in the orthodontic field since the 1990s, greatly expanding the scope of orthodontic treatment. 1-4 The need of orthognathic surgery with general anaesthesia has been reduced dramatically by using TSADs to effectively treat mild and moderate dento-alveolar dysplasia. Non-extraction Class II correction can be accomplished by distalizing molars. Four other examples are as follows: transverse correction with minimum flaring of maxillary alveolar segments, closing the bite with molar intrusion, correction of a Class III anterior cross bite using TSAD in combination with minor segmental osteotomy and efficient anterior canting correction. 5-7 Biocreative Orthodontic Strategy (BOS) was developed in 1979, established and systemized in 1998. 3,4 It is a diagnostic treatment method that uses TSADs not only as an anchorage necessary for orthodontic treatment, but also as an active driving appliance with the aim of obtaining physiologically stable occlusion (Figure 1). 8 It can be especially advantageous in patients with anatomical limitations, skeletal discrepancies or bone loss. 4 In this protocol, biomechanics are simplified, forces are targeted to avoid forces to susceptible teeth, fewer fixed attachments are used, and the number of TSADs is minimized. 9,10 The key principles of BOS are specific to the growth stage of the patient. We have four principles for young patients and six principles for adults. 4,11 Using initial letters of ten principles, we made a phrase:
“…Going back to the ‘TAKE ACTION’ principles, the importance of orthodontic management of upper airway applies to both growing and non‐growing orthodontic patients 4,11 . In growing patients, the goals of early treatment in BOS include favourable upper airway development by accomplishing a stable tripod relationship between nasomaxillary complex and mandible relative to the cranial base 57 . The combined protocol of the horseshoe‐type maxillary expander and tongue elevator with myofunctional training is an airway‐friendly growth modification treatment for pre‐school and school age groups.…”
Temporary skeletal anchorage devices (TSADs) have been used in the orthodontic field since the 1990s, greatly expanding the scope of orthodontic treatment. 1-4 The need of orthognathic surgery with general anaesthesia has been reduced dramatically by using TSADs to effectively treat mild and moderate dento-alveolar dysplasia. Non-extraction Class II correction can be accomplished by distalizing molars. Four other examples are as follows: transverse correction with minimum flaring of maxillary alveolar segments, closing the bite with molar intrusion, correction of a Class III anterior cross bite using TSAD in combination with minor segmental osteotomy and efficient anterior canting correction. 5-7 Biocreative Orthodontic Strategy (BOS) was developed in 1979, established and systemized in 1998. 3,4 It is a diagnostic treatment method that uses TSADs not only as an anchorage necessary for orthodontic treatment, but also as an active driving appliance with the aim of obtaining physiologically stable occlusion (Figure 1). 8 It can be especially advantageous in patients with anatomical limitations, skeletal discrepancies or bone loss. 4 In this protocol, biomechanics are simplified, forces are targeted to avoid forces to susceptible teeth, fewer fixed attachments are used, and the number of TSADs is minimized. 9,10 The key principles of BOS are specific to the growth stage of the patient. We have four principles for young patients and six principles for adults. 4,11 Using initial letters of ten principles, we made a phrase:
Introducción: El síndrome de apnea obstructiva del sueño (SAOS) es un trastorno respiratorio del sueño frecuente, caracterizado por episodios de obstrucción parcial o total de las vías respiratorias durante el sueño. La expansión maxilar rápida se ha propuesto como un posible tratamiento de esta patología en niños ya que su uso aumentaría el volumen de la vía aérea superior. Sin embargo, su uso para el tratamiento de apnea obstructiva del sueño es controvertido. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos seis revisiones sistemáticas que en conjunto incluyeron 23 estudios primarios. Concluimos que no es posible establecer con claridad el efecto del uso de la expansión maxilar sobre el índice de apnea-hipoapnea, eficiencia y tiempo del sueño, y microdespertares por causa respiratoria, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja. No se encontraron estudios que evaluaran los efectos adversos ni la somnolencia diurna de los pacientes sometidos a expansión maxilar.
“…the pharynx related to anatomical morphology, which causes collapse of the upper airway through inspiration during sleep. [7][8][9][10] The increased upper airway resistance and pharyngeal collapse result in airway obstruction and inhibit normal respiration, which result in prolonged partial (hypopnea) or intermittent complete (apnoea) obstruction of airflow. 7,8,11 In adult patients, a hypopnea or apnoea is defined to last ≥10 s.…”
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confidence: 99%
“…11 The diagnosis of OSA is confirmed by an overnight polysomnography (PSG) or polygraphy (PG). 1,6,9,11,[14][15][16] The PSG is the gold standard measuring the electric activity in the brain, eye movement, muscular activity in head and legs, thoracic and abdominal motion, respiratory flow, oxygen saturation, pulse, body position, actigraphy and audio recording (breathing and snoring). 6 During PG, the electric activity in the brain, eye movement, muscular activity in head and legs are not measured-but all other mentioned measurements are included in the PG.…”
mentioning
confidence: 99%
“…17 SDB causes interruption of sleep, which can result in daytime sleepiness, irritability, nocturnal enuresis, failure to thrive, learning disabilities and reduced growth. 1,2,4,5,18 The main predisposing factors to SDB in children are adenoid vegetations and/or adenotonsillar hypertrophy 9,11,14,19,20 or craniofacial syndromes in relation to decreased space in the upper airway. 11 Other predisposing factors such as overweight 19 and disturbance of the neuromotor response in the upper airway 21 have been identified.…”
Sleep is essential and important for growth, development, learning and well-being in children and adolescents. Symptoms of sleep problems in schoolchildren can be bedtime resistance, difficulty initiating sleep because of anxiety, daytime sleepiness and nocturnal enuresis.Sleep problems can be caused by sleep-disordered breathing (SDB) such as obstructive sleep apnoea (OSA), insufficient sleep, delayed sleep-wake phase disorder and/or anxiety disorders. [1][2][3] The prevalence of OSA in children and adolescents is 1-5%-but may be underdiagnosed. [4][5][6] OSA is caused by central, sleep-induced neuromuscular hypotonia, in conjunction with decreased space in
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