Treatment of Paediatric Obstructive Sleep Apnoea with Oral Appliances

E-mail [email protected] Obstructive sleep apnoea syndrome (OSAS) is a disorder of breathing during sleep characterised by prolonged partial airway obstruction and/ or intermittent complete obstruction (obstructive apnoea) that interrupts normal ventilation during sleep and disrupts normal sleep pattern, affecting about 2–3% of children [1, 2]. Although adenotonsillar hypertrophy remains the main causative factors inducing OSAS in children, other conditions involving a reduction of the calibre of the upper airways, such as craniofacial dysmorphism, obesity, hypotonic neuromuscular diseases, can be aetiologic factors [3, 4]. Orthodontic and craniofacial abnormalities are commonly ignored, despite many children with OSA displaying mild craniofacial morphometric anomalies [5–8]. Figure 1 shows the typical and common phenotype of a child with OSA, displaying a long face and narrow palate. A narrow upper airway accompanied by maxillary constriction and mandibular retrusion is commonly reported [4, 6, 8, 9] with a skeletal conformation showing hyperdivergent skeletal growth pattern. All these factors induce an increase of the craniomandibular, intermaxillary, goniac and mandibular angles [10]. Similarly to the major congenital craniofacial anomalies, a mandibular retroposition is associated with posterior displacement of the tongue base, which increase the upper airway narrowing and leads to a high-arched (ogival) palate (fig. 2) [10, 11]. It is still debated whether these morphological features are genetically determined or influenced by the early onset of habitual snoring, and their reversibility by adenotonsillectomy (AT) has yet to be determined [10].