Upper Airway Sleep Disorders in Children: Orthodontist\'s Role

Abstract

Significant component of craniofacial development occurs within the first four years of life. A total of 90% of the craniofacial development is complete by the age of 12 years. Therefore, it can be concluded that morphometric features that puts an adult at risk of obstructive sleep apnoea(OSA)or sleep disordered breathing (SDB) were probably present at the age of 12 years. Class II malocclusions, narrow maxilla, mandibular deficiency, retrognathia, long face problems, inferiorly and posteriorly placed hyoid bone are all considered as craniofacial anomalies that predisposes a child to SDB. Craniofacial anatomy can influence the upper airway and environmental factors, like adenotonsillitis, nasal allergy, pernicious oral habits (prolonged pacifier use, thumb sucking, tongue thrusting and mouth breathing), and can also influence the growth and development of the craniofacial complex. It has been stated that mouth breathing as an ongoing pattern may be a sign of impending sleep apnoea. So it is of paramount importance for the healthcare professionals to keep a close eye on the risk factors and make appropriate referrals for requisite preventive, interceptive and corrective treatment. Promotion and propagation of breast feeding in infants, adeno-tonsillectomy, maxillary expansion and functional appliances aimed at posturing the mandible in forward position/optimal position, habit breaking appliances and maxilla-mandibular distraction osteogenesiss are the preventive, interceptive and corrective treatment options at our disposal. This communication is aimed at providing an overview of orthodontist's role in the management of upper airway sleep disorders in children in the back drop of craniofacial risk factors, environmental influences and appropriate orthodontic and dentofacial orthopaedic intervention strategies. are also seen in children. OSA is estimated to occur in 1%-3% of children and snoring is believed to occur in 3%-12% of the population 1,2. Management of SDB in children is by an interdisciplinary approach involving paediatrician, oto-rhino-laryngologist, pulmonologist, orthodontist, maxillofacial surgeon and speech therapist. SDB, particularly OSA, affects memory, school performance, growth and development, cardiorespiratory health in children 3-6. Craniofacial development is almost 90% complete by the age of 12 years. Hence, all those craniofacial risk factors that are