Top

Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie

Published in:

01-03-2016 | Original Article

Sleep-disordered breathing in orthodontic practice

Prevalence of snoring in children and morphological findings

Authors: Dr. Isabelle Graf, Uwe Schumann, Julia Neuschulz, Karolin Höfer, Lutz Ritter, Bert Braumann

Published in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie | Issue 2/2016

Abstract

Objectives

The purpose of this work was to evaluate the prevalence of snoring and its correlation with cranial and upper airway morphology in young individuals with orthodontic treatment need.

Patients and methods

Parents of 379 children were consecutively interviewed, using eight questions from a more comprehensive questionnaire about sleep behavior. A total of 100 patients (54 girls, 46 boys, average age 11.3 years) met the inclusion criteria. Based on the parents’ interviews, the sample was divided into snorers (n = 53) and nonsnorers (n = 47). Using cephalograms obtained for initial orthodontic diagnostics, airway morphology was measured based on hyoid position and on the posterior airway space (PAS) dimensions at the maxillary, occlusal, and mandibular plane levels (PAS_NL, PAS_OCCL, PAS_ML). Mann–Whitney U testing, ANOVA, and Spearman’s rank correlation coefficient were used for statistical analysis.

Results

Snoring was reported by 53 % of parents for 63 % (n = 29) of the boys and 44 % (n = 24) of the girls. Significant morphological differences were noted between snorers and nonsnorers. PAS dimensions were significantly reduced in the snorers compared to the nonsnorers at all three anatomical levels tested, which remained statistically significant when adjusted for age and gender. No differences between the two groups emerged for hyoid position or any of the vertical cranial parameters. A significant correlation between sagittal maxillary position (SNA) and PAS_NL was noted, indicating that larger SNA values were mildly associated with larger sagittal PAS dimensions at the maxillary level.

Conclusion

This random sample of young patients with orthodontic treatment need was found to involve a high prevalence of parent-reported snoring. Characteristic features in cranial and upper airway morphology and thus differences between the snorers and nonsnorers were found.

Carra MC, Huynh N, Morton P et al (2011) Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7-to 17-yr-old population. Eur J Oral Sci 119(5):386–394CrossRefPubMed

Pirila-Parkkinen K, Lopponen H, Nieminen P et al (2010) Cephalometric evaluation of children with nocturnal sleep-disordered breathing. Eur J Orthod 32(6):662–671CrossRefPubMed

Wiater A, Paditz E, Schlüter B et al (2002) Obstruktives Schlafapnoesyndrom im Kindesalter. Dtsch Arztebl 99(49):3324–3330

Ali NJ, Pitson DJ, Stradling JR (1993) Snoring, sleep disturbance, and behaviour in 4–5 year olds. Arch Dis Child 68(3):360–366CrossRefPubMedPubMedCentral

Ali NJ, Pitson D, Stradling JR (1994) Natural history of snoring and related behaviour problems between the ages of 4 and 7 years. Arch Dis Child 71(1):74–76CrossRefPubMedPubMedCentral

Gislason T, Benediktsdottir B (1995) Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest 107(4):963–966CrossRefPubMed

Lofstrand-Tidestrom B, Thilander B et al (1999) Breathing obstruction in relation to craniofacial and dental arch morphology in 4-year-old children. Eur J Orthod 21(4):323–332CrossRefPubMed

Lumeng JC, Chervin RD (2008) Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5:242–252CrossRefPubMedPubMedCentral

Baldassari CM, Mitchell RB, Schubert C et al (2008) Pediatric obstructive sleep apnea and quality of life: a meta-analysis. Otolaryngol Head Neck Surg 138(3):265–273CrossRefPubMed

10.

Carroll JL (2003) Obstructive sleep-disordered breathing in children: new controversies, new directions. Clin Chest Med 24(2):261–282CrossRefPubMed

11.

Guilleminault C, Pelayo R, Leger D et al (1996) Recognition of sleep-disordered breathing in children. Pediatrics 98(5):871–882PubMed

12.

Guilleminault C, Quo SD (2001) Sleep-disordered breathing. A view at the beginning of the new Millennium. Dent Clin North Am 45(4):643–656PubMed

13.

Shur-Fen Gau S, Shur-Fen GS (2006) Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6–15 in Taiwan. J Sleep Res 15(4):403–414CrossRefPubMed

14.

Battagel JM, Johal A, Kotecha B (2000) A cephalometric comparison of subjects with snoring and obstructive sleep apnoea. Eur J Orthod 22(4):353–365CrossRefPubMed

15.

Battagel JM, L’Estrange PR (1996) The cephalometric morphology of patients with obstructive sleep apnoea (OSA). Eur J Orthod 18(6):557–569CrossRefPubMed

16.

DeBerry-Borowiecki B, Kukwa A, Blanks RH (1988) Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 98(2):226–234CrossRefPubMed

17.

Hochban W, Brandenburg U (1994) Morphology of the viscerocranium in obstructive sleep apnoea syndrome- cephalometric evaluation of 400 patients. J Craniomaxillofac Surg 22(4):205–213CrossRefPubMed

18.

Rintala A, Nordstrom R, Partinen M et al (1991) Cephalometric analysis of the obstructive sleep apnea syndrome. Proc Finn Dent Soc 87(1):177–182PubMed

19.

Finkelstein Y, Wexler D, Berger G et al (2000) Anatomical basis of sleep-related breathing abnormalities in children with nasal obstruction. Arch Otolaryngol Head Neck Surg 126(5):593–600CrossRefPubMed

20.

Huang Y-S, Guilleminault C (2013) Pediatric obstructive sleep apnea and the critical role of oro-facial growth: evidences. Front Neurol 3(184):1–7

21.

Katyal V, Pamula Y, Martin AJ et al (2013) Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis. Am J Orthod Dentofac Orthop 143(1):20–30 e23

22.

Hinz R, Paeske I (2007) Kieferanomalien—Ursache des nicht erholsamen Kinderschlafes. ZM 97(18):40–49

23.

Hochban W (1995) Das obstruktive Schlafapnoesyndrom—Diagnostik und Therapie unter Berücksichtigung kraniofazialer Anomalien. Blackwell Wissenschaftsverlag, Berlin

24.

Dahlberg G (1940) Statistical methods for medical and biological students. Interscience Publications, New York

25.

Castronovo V, Zucconi M, Nosetti L et al (2003) Prevalence of habitual snoring and sleep-disordered breathing in preschool-aged children in an Italian community. J Pediatr 142(4):377–382CrossRefPubMed

26.

Tang J, Rosen CL, Larkin EK et al (2002) Identification of sleep-disordered breathing in children: variation with event definition. Sleep 25(1):72–79PubMed

27.

Ersu R, Arman AR, Save D et al (2004) Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in istanbul. Chest 126(1):19–24CrossRefPubMed

28.

El H, Palomo JM (2013) An airway study of different maxillary and mandibular sagittal positions. Eur J Orthod 35(2):262–270CrossRefPubMed

29.

Kim YJ, Hong JS, Hwang YI et al (2010) Three-dimensional analysis of pharyngeal airway in preadolescent children with different anteroposterior skeletal patterns. Am J Orthod Dentofac Orthop 137(3):306.e1–306.e11

30.

Kochel J, Meyer-Marcotty P, Sickel F et al (2013) Short-term pharyngeal airway changes after mandibular advancement surgery in adult Class II-Patients-a three-dimensional retrospective study. J Orofac Orthop 74(2):137–152CrossRefPubMed

31.

Deutsche Gesellschaft für Zahn-, Mund-, und Kieferheilkunde (2013) S2k-Leitlinie: Dentale digitale Volumentomographie (DVT). http://www.awmf.org/uploads/tx_szleitlinien/083-005l_S2k_Dentale_Volumentomographie_2013-10.pdf. Accessed 01 June 2014

32.

Oz U, Orhan K, Abe N (2011) Comparison of linear and angular measurements using two-dimensional conventional methods and three-dimensional cone beam CT images reconstructed from a volumetric rendering program in vivo. Dento Maxillo Facial Radiol 40(8):492–500CrossRef

33.

Pirila-Parkkinen K, Lopponen H, Nieminen P et al (2011) Validity of upper airway assessment in children: a clinical, cephalometric, and MRI study. Angle Orthod 81(3):433–439CrossRefPubMed

34.

Bhatia SN, Leighton BC (1993) A manual of facial growth: a computer analysis of longitudinal cephalometric growth data. Oxford University Press, Oxford

35.

Claudino LV, Mattos CT, Ruellas AC et al (2013) Pharyngeal airway characterization in adolescents related to facial skeletal pattern: a preliminary study. Am J Orthod Dentofac Orthop 143(6):799–809CrossRef

36.

Bollhalder J, Hanggi MP, Schatzle M et al (2013) Dentofacial and upper airway characteristics of mild and severe class II division 1 subjects. Eur J Orthod 35(4):447–453CrossRefPubMed

37.

Ceylan I, Oktay H (1995) A study on the pharyngeal size in different skeletal patterns. Am J Orthod Dentofac Orthop 108(1):69–75CrossRef

38.

Eklund M, Kotilainen J, Evalahti M et al (2012) Cephalometric analysis of pharyngeal airway space dimensions in Turner syndrome. Eur J Orthod 34(2):219–225CrossRefPubMed

39.

DeFreitas MR, Alcazar NM, Janson G et al (2006) Upper and lower pharyngeal airways in subjects with Class I and Class II malocclusions and different growth patterns. Am J Orthod Dentofac Orthop 130(6):742–745CrossRef

40.

Frohberg U, Naples RJ, Jones DL (1995) Cephalometric comparison of characteristics in chronically snoring patients with and without sleep apnea syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 80(1):28–33CrossRefPubMed

Title: Sleep-disordered breathing in orthodontic practice
Prevalence of snoring in children and morphological findings
Authors: Dr. Isabelle Graf
Uwe Schumann
Julia Neuschulz
Karolin Höfer
Lutz Ritter
Bert Braumann
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie / Issue 2/2016
Print ISSN: 1434-5293
Electronic ISSN: 1615-6714
DOI: https://doi.org/10.1007/s00056-016-0017-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Sleep-disordered breathing in orthodontic practice

Prevalence of snoring in children and morphological findings

Abstract

Objectives

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2016

Shear bond strength of brackets on restorative materials

Virtual facial reconstruction based on accurate registration and fusion of 3D facial and MSCT scans

Oral health-related quality of life after orthodontic treatment for anterior tooth alignment

Compensation of skeletal Class III malocclusion by isolated extraction of mandibular teeth

Natural head position and lower incisor irregularity

Nickel ion concentrations in the saliva of patients treated with self-ligating fixed appliances: a prospective cohort study