Prevalence of malocclusions and oral dysfunctions in children with persistent sleep-disordered breathing after adenotonsillectomy in the long term

Abstract

Study Objectives: To evaluate the prevalence of craniofacial/orthodontic abnormalities and oral dysfunctions in a population of children with persistent sleep-disordered breathing despite adenotonsillectomy. Methods: Medical charts of 4,000 children with sleep-disordered breathing operated on in a tertiary hospital were retrospectively reviewed. Patients reporting persistent sleep-disordered breathing symptoms were invited to an orthodontic/myofunctional evaluation following the Sleep Clinical Score), followed by a 1-night ambulatory type III sleep study. Results: One hundred nonsyndromic symptomatic patients were examined (mean age 8.8 ± 3.5 years), from 1 to 12 years after surgery (mean 4.6 ± 3.1 years); 24% were overweight/obese; 69 had a sleep study. Although prevalent, oronasal abnormalities and malocclusions were not specifically associated with pathological sleep parameters (cartilage hypotonia 18%, septal deviation 5%, short lingual frenulum 40%). Malocclusions were associated with a higher respiratory event index in children under 8 years only, whereas an impaired nasal dilator reflex and tongue immaturity were associated with an increased obstructive respiratory event index in all patients (1.72 ± 2.29 vs 0.72 ± 1.22 events/h, P = .011) and Respiratory Event Index, respectively (3.63 ± 3.63 vs 1.19 ± 1.19 events/h). Male sex, phenotype, nasal obstruction, oral breathing, and young age at surgery (< 3 years) were significantly related to higher respiratory event index. Using the Sleep Clinical Score > 6.5 cut-off, patients with persistent sleep apnea were significantly distinct from chronic snoring (2.72 ± 2.67 vs 0.58 ± 0.55, P < .01). Conclusions: Oronasal anatomical and functional abnormalities were quite prevalent and various in persistent sleep-disordered breathing after adenotonsillectomy. Nasal disuse and tongue motor immaturity were associated with a higher obstructive respiratory event index in the long term, whereas craniofacial risk factors might have a more pronounced impact at younger age.

Specific dento‐craniofacial characteristics in non‐syndromic children can predispose to sleep‐disordered breathing

“…However, obesity, which is a prevalent risk factor of SDB, is increasingly seen in children aged 6 to 9 years 1,8–10 . Obese children have anatomically increased parapharyngeal fat pad and lymphoid tissues that narrow and increase the collapsibility of the airway 8,11 . In addition, overweight has a major impact on the treatment effect of adenotonsillectomy 8,9,11 …”

“…Obese children have anatomically increased parapharyngeal fat pad and lymphoid tissues that narrow and increase the collapsibility of the airway 8,11 . In addition, overweight has a major impact on the treatment effect of adenotonsillectomy 8,9,11 1,8,11–13 .…”

“…In addition, overweight has a major impact on the treatment effect of adenotonsillectomy 8,9,11 1,8,11–13 . In general, the oropharyngeal muscles affect the oral function, including the swallowing mechanism and the upper airway dimensions.…”

“…In general, the oropharyngeal muscles affect the oral function, including the swallowing mechanism and the upper airway dimensions. A reduced tone of the oropharyngeal muscles can affect the swallowing mechanism and increases risk of airway obstruction during sleep 1,11,14 . In contrast to adults, the prevalence of SDB in children is not associated with age or sex 8 .…”

A century of adenotonsillectomy’s failure to fully resolve sleep-disordered breathing: mild malocclusions are maybe not so mild?

“…The authors of the study by Cohen-Levy et al 1 in this issue of the Journal of Clinical Sleep Medicine are to be commended for their well-organized and strongly referenced reporting on the highly prevalent problem of persistent sleep-disordered breathing (SDB) in children following adenotonsillectomy or adenoidectomy solely. Within recently published literature, postsurgical SDB symptom recurrence is described as both a short-term 2,3 and long term 4 problem; and according to the late Christian Guilleminault 5 , "it appears that we cannot assume that T&A alone can be relied upon to sufficiently restore normal breathing during sleep.…”