Publication: Prevalance of sleep-disorded breathing and efficacy of twin block appliance treatment in saudi children with class ii malocclusion and obstructive sleep apnoea
Loading...
Date
2024-12
Authors
Zreaqat, Ma’en Hussni Rashid
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Obstructive sleep apnoea (OSA) is a disorder of breathing during sleep
characterized by prolonged partial upper airway obstruction and/or intermittent complete
obstruction that disrupts normal ventilation during sleep and normal sleep patterns. It is
an increasing major public health concern worldwide, partly resulting from the obesity
epidemic which has encroached into the pediatric population. Individuals with a Class II
skeletal malocclusion may suffer from snoring due to a retrognathic position of the
mandible resulting in a retro-glossal tongue position which restricts posterior pharyngeal
airway space which may result in obstructive sleep apnoea. This sleep pathology carries
devastating health consequences resulting in hypertension, ischemic heart disease and
stroke and associated with insulin resistance. Children who are sleep deprived often
demonstrate nocturnal enuresis, daytime fatigue, hyperactivity and poor performance at
school. Early recognition of this condition through routine dental clinical examination,
standard screening questionnaires, and further craniofacial cephalometric analysis may
help in early diagnosis and treatment. There is a growing body of evidence that shows
the effective role of myofunctional appliances in the management of obstructive sleep
apnoea associated with Class II skeletal malocclusion. The anterior displacement of the
mandible guided by this device is able to widen the posterior pharyngeal airway space,
reducing the upper airway resistance and improves airflow while breathing throughout the night. The aims of this study were first: To determine the prevalence of sleep
disordered breathing among Saudi school children as a population-based study using the
Pediatric Sleep Questionnaire (PSQ), and second: To evaluate the impact of twin block
management on upper airway CBCT dimensions, oropharynx parameters, biochemical
levels, and quality of life in OSA children with Class II skeletal malocclusion. This
prospective cohort study comprised polysomnography-proven OSA growing children
with class II skeletal malocclusion and mandibular retrognathia in the age range of 8 to
12 years who have completed twin block treatment and matched corresponding controls.
Results showed that twenty three percent of Saudi school children were at high risk of
developing SDB with male predilection as a risk factor. Snoring, sleep apnoea, and
mouth breathing were prevalent in high-risk SDB children. There is a strong association
between increased body mass index (BMI) and SDB. The epidemic spread of obesity
among Saudi school children and its negative impacts merit serious discussion in future
health strategies. Male gender, increased BMI, high tonsil and Mallampati scores were
clinical indicators of the presence of OSA. However, only Mallampati scale was
associated with severity of OSA. Due to the financial burden for of polysomnography
(PSG), clinical diagnostic indicators should be established and encouraged especially in
community based studies. The results of CBCT scans analysis showed that children with
OSA have a smaller oropharynx volume, minimum cross-sectional area (CSAmin),
anterio-posterior and lateral dimensions of CSAmin, hypopharynx CSAmin, and increased
upper airway length compared to corresponding controls. A small CSAmin seems to be
the most relevant anatomical variable in the pathogenesis of OSA. The current study
shows that correction of class II skeletal malocclusion and mandibular retrognathia with
twin-block appliance resulted in significant increase of upper air way parameters.