Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion

• Published in: American journal of orthodontics and dentofacial orthopedics 2013-12, Vol.144 (6), p.860-871
• Main Authors: Katyal, Vandana, Pamula, Yvonne, Daynes, Cathal N, Martin, James, Dreyer, Craig W, Kennedy, Declan, Sampson, Wayne J
• Format: Article
• Language: English
• Subjects: Adolescent; Case-Control Studies; Cephalometry - methods; Child; Dentistry; Female; Humans; Male; Malocclusion - diagnosis; Malocclusion - therapy; Maxilla - anatomy & histology; Nose - anatomy & histology; Palatal Expansion Technique; Palate - anatomy & histology; Pharynx - anatomy & histology; Prevalence; Prospective Studies; Quality of Life; Risk Factors; Sleep Apnea Syndromes - pathology; Surveys and Questionnaires
• ISSN: 0889-5406; 1097-6752
• DOI: 10.1016/j.ajodo.2013.08.015

Introduction The association between pediatric sleep-disordered breathing caused by upper airway obstruction and craniofacial morphology is poorly understood and contradictory. The aims of this study were to evaluate the prevalence of children at risk for sleep-disordered breathing, as identified in an orthodontic setting by validated screening questionnaires, and to examine associations with their craniofacial and upper airway morphologies. A further aim was to assess the change in quality of life related to sleep-disordered breathing for affected children undergoing rapid maxillary expansion to correct a palatal crossbite or widen a narrow maxilla. Methods A prospective case-control study with children between 8 and 17 years of age (n = 81) at an orthodontic clinic was undertaken. The subjects were grouped as high risk or low risk for sleep-disordered breathing based on the scores from a validated 22-item Pediatric Sleep Questionnaire and the Obstructive Sleep Apnea-18 Quality of Life Questionnaire. Variables pertaining to a screening clinical examination, cephalometric assessment, and dental cast analysis were tested for differences between the 2 groups at baseline. Ten children who underwent rapid maxillary expansion were followed longitudinally until removal of the appliance approximately 9 months later with a repeated Obstructive Sleep Apnea-18 Quality of Life Questionnaire. All data were collected blinded to the questionnaire results. Results The frequency of palatal crossbite involving at least 3 teeth was significantly higher in the high-risk group at 68.2%, compared with the low-risk group at 23.2% ( P