Skip to main content
Top
Published in: Sleep and Breathing 4/2012

01-12-2012 | Review

Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome

Authors: Maria Pia Villa, Silvia Miano, Alessandra Rizzoli

Published in: Sleep and Breathing | Issue 4/2012

Login to get access

Abstract

Background

Orthodontic and craniofacial abnormalities have often been reported in pediatric sleep-disordered breathing (SDB). While the reversibility of these craniofacial abnormalities by means of adenotonsillectomy has yet to be established, orthodontic treatment based on oral appliances is considered to be a potential additional treatment for pediatric SDB.

Discussion

Oral appliances may help improve upper airway patency during sleep by enlarging the upper airway and/or by decreasing upper airway collapsibility, thereby enhancing upper airway muscle tone. Orthodontic therapy should be encouraged in pediatric OSAS, and an early approach may permanently modify nasal breathing and respiration, thereby preventing obstruction of the upper airway.
Literature
1.
go back to reference Arens R, Marcus CL (2004) Pathophysiology of upper airway obstruction: a developmental perspective. Sleep 27:997–1019PubMed Arens R, Marcus CL (2004) Pathophysiology of upper airway obstruction: a developmental perspective. Sleep 27:997–1019PubMed
2.
go back to reference Guilleminault C, Li KK, Khramtsov A, Pelayo R, Martinez S (2004) Sleep disordered breathing: surgical outcomes in prepubertal children. Laryngoscope 114:132–137PubMedCrossRef Guilleminault C, Li KK, Khramtsov A, Pelayo R, Martinez S (2004) Sleep disordered breathing: surgical outcomes in prepubertal children. Laryngoscope 114:132–137PubMedCrossRef
3.
go back to reference Guilleminault C, Partinen M, Praud JP, Quera-Salva MA, Powell N, Riley R (1989) Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr 114:997–999PubMedCrossRef Guilleminault C, Partinen M, Praud JP, Quera-Salva MA, Powell N, Riley R (1989) Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr 114:997–999PubMedCrossRef
4.
go back to reference Kawashima S, Peltomaki T, Sakata H, Mori K, Happonen RP, Ronning O (2002) Craniofacial morphology in preschool children with sleep-related breathing disorder and hypertrophy of tonsils. Acta Paediatr 91:71–77PubMedCrossRef Kawashima S, Peltomaki T, Sakata H, Mori K, Happonen RP, Ronning O (2002) Craniofacial morphology in preschool children with sleep-related breathing disorder and hypertrophy of tonsils. Acta Paediatr 91:71–77PubMedCrossRef
5.
go back to reference Mitchell RB, Kelly J (2004) Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 68:1375–1379PubMedCrossRef Mitchell RB, Kelly J (2004) Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 68:1375–1379PubMedCrossRef
6.
go back to reference Shintani T, Asakura K, Kataura A (1996) Adenotonsillar hypertrophy and skeletal morphology of children with obstructive sleep apnea syndrome. Acta Otolaryngol 523:S222–S224 Shintani T, Asakura K, Kataura A (1996) Adenotonsillar hypertrophy and skeletal morphology of children with obstructive sleep apnea syndrome. Acta Otolaryngol 523:S222–S224
7.
go back to reference Tasker C, Crosby JH, Stradling JR (2002) Evidence for persistence of upper airway narrowing during sleep, 12 years after adenotonsillectomy. Arch Dis Child 86:34–37PubMedCrossRef Tasker C, Crosby JH, Stradling JR (2002) Evidence for persistence of upper airway narrowing during sleep, 12 years after adenotonsillectomy. Arch Dis Child 86:34–37PubMedCrossRef
8.
go back to reference Agren K, Nordlander B, Linder-Aronsson S, Zettergren-Wijk L, Svanborg E (1998) Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement. Acta Otolaryngol 118:581–587PubMedCrossRef Agren K, Nordlander B, Linder-Aronsson S, Zettergren-Wijk L, Svanborg E (1998) Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement. Acta Otolaryngol 118:581–587PubMedCrossRef
9.
go back to reference Kulnis R, Nelson S, Strohl K, Hans M (2000) Cephalometric assessment of snoring and nonsnoring children. Chest 118:596–603PubMedCrossRef Kulnis R, Nelson S, Strohl K, Hans M (2000) Cephalometric assessment of snoring and nonsnoring children. Chest 118:596–603PubMedCrossRef
10.
go back to reference Shintani T, Asakura K, Kataura A (1997) Evaluation of the role of adenotonsillar hypertrophy and facial morphology in children with obstructive sleep apnea. ORL J Otorhinolaryngol Relat Spec 59:286–291PubMedCrossRef Shintani T, Asakura K, Kataura A (1997) Evaluation of the role of adenotonsillar hypertrophy and facial morphology in children with obstructive sleep apnea. ORL J Otorhinolaryngol Relat Spec 59:286–291PubMedCrossRef
11.
go back to reference Zucconi M, Caprioglio A, Calori G, Ferini-Strambi L, Oldani A, Castronovo C, Smirne S (1999) Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case–control study. Eur Respir J 13:411–417PubMedCrossRef Zucconi M, Caprioglio A, Calori G, Ferini-Strambi L, Oldani A, Castronovo C, Smirne S (1999) Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case–control study. Eur Respir J 13:411–417PubMedCrossRef
12.
go back to reference Goldbart AD, Goldman JL, Veling MC, Gozal D (2005) Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 172:364–370PubMedCrossRef Goldbart AD, Goldman JL, Veling MC, Gozal D (2005) Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 172:364–370PubMedCrossRef
13.
go back to reference Villa MP, Malagola C, Pagani J, Montesano M, Rizzoli A, Guilleminault C, Roberto R (2007) Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12 months follow-up. Sleep Med 8:128–134PubMedCrossRef Villa MP, Malagola C, Pagani J, Montesano M, Rizzoli A, Guilleminault C, Roberto R (2007) Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12 months follow-up. Sleep Med 8:128–134PubMedCrossRef
14.
go back to reference Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 9:469–477PubMed Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 9:469–477PubMed
15.
go back to reference Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RW, Darendeliler MA, Cistulli PA (2010) The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 65:726–732PubMedCrossRef Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RW, Darendeliler MA, Cistulli PA (2010) The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 65:726–732PubMedCrossRef
16.
go back to reference Miano S, Rizzoli A, Evangelisti M, Bruni O, Ferri R, Pagani J, Villa MP (2009) NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome. Sleep Med 10:471–478PubMedCrossRef Miano S, Rizzoli A, Evangelisti M, Bruni O, Ferri R, Pagani J, Villa MP (2009) NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome. Sleep Med 10:471–478PubMedCrossRef
17.
go back to reference Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262PubMed Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262PubMed
18.
go back to reference American Sleep Disorders Association (1995) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. Sleep 18:511–513 American Sleep Disorders Association (1995) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. Sleep 18:511–513
19.
go back to reference Kheirandish L, Goldbart AD, Gozal D (2006) Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 117:e61–e66PubMedCrossRef Kheirandish L, Goldbart AD, Gozal D (2006) Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 117:e61–e66PubMedCrossRef
20.
go back to reference Cartwright R, Ferguson K, Rogers R, Schmidt-Nowara W (2005) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262 Cartwright R, Ferguson K, Rogers R, Schmidt-Nowara W (2005) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262
21.
go back to reference Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer JP, American Academy of Sleep (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29:240–243PubMed Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer JP, American Academy of Sleep (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29:240–243PubMed
22.
go back to reference Bloch KE (2006) Alternatives to CPAP in the treatment of the obstructive sleep apnea syndrome. Swiss Med Wkly 136:261–267PubMed Bloch KE (2006) Alternatives to CPAP in the treatment of the obstructive sleep apnea syndrome. Swiss Med Wkly 136:261–267PubMed
23.
go back to reference Ng AT, Gotsopoulos H, Qian J, Cistulli PA (2003) Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med 168:238–241PubMedCrossRef Ng AT, Gotsopoulos H, Qian J, Cistulli PA (2003) Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med 168:238–241PubMedCrossRef
24.
go back to reference Lim J, Lasserson TJ, Fleetham J, Wright J (2006) Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev 25:CD004435 Lim J, Lasserson TJ, Fleetham J, Wright J (2006) Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev 25:CD004435
25.
go back to reference Carvalho FR, Lentini-Oliveira D, Machado MA, Prado GF, Prado LB, Saconato H (2007) Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database Syst Rev 18:CD005520 Carvalho FR, Lentini-Oliveira D, Machado MA, Prado GF, Prado LB, Saconato H (2007) Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database Syst Rev 18:CD005520
26.
go back to reference Pirelli P, Saponara M, Guilleminault C (2004) Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep 27:761–766PubMed Pirelli P, Saponara M, Guilleminault C (2004) Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep 27:761–766PubMed
27.
go back to reference Sistema nazionale le linee guida (2008) Appropriatezza e sicurezza degli interventi di tonsillectomia e/o adenoidectomia. Documento 15 Sistema nazionale le linee guida (2008) Appropriatezza e sicurezza degli interventi di tonsillectomia e/o adenoidectomia. Documento 15
28.
go back to reference Monini S, Malagola C, Villa MP, Tripodi C, Tarentini S, Malagnino I, Marrone V, Lazzarino AI, Barbara M (2009) Rapid maxillary expansion for the treatment of nasal obstruction in children younger than 12 years. Arch Otolaryngol Head Neck Surg 135:22–27PubMedCrossRef Monini S, Malagola C, Villa MP, Tripodi C, Tarentini S, Malagnino I, Marrone V, Lazzarino AI, Barbara M (2009) Rapid maxillary expansion for the treatment of nasal obstruction in children younger than 12 years. Arch Otolaryngol Head Neck Surg 135:22–27PubMedCrossRef
29.
go back to reference Ramires T, Maia RA, Barone JR (2008) Nasal cavity changes and the respiratory standard after maxillary expansion. Rev Bras Otorrinolaringol 74:763–769CrossRef Ramires T, Maia RA, Barone JR (2008) Nasal cavity changes and the respiratory standard after maxillary expansion. Rev Bras Otorrinolaringol 74:763–769CrossRef
30.
go back to reference Cistulli PA, Palmisano RG, Poole MD (1998) Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep 21:831–835PubMed Cistulli PA, Palmisano RG, Poole MD (1998) Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep 21:831–835PubMed
31.
go back to reference Villa MP, Bernkopf E, Pagani J, Broia V, Montesano M, Ronchetti R (2002) Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med 165:123–127PubMed Villa MP, Bernkopf E, Pagani J, Broia V, Montesano M, Ronchetti R (2002) Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med 165:123–127PubMed
32.
go back to reference Brouillette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C (1984) A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 105:10–14CrossRef Brouillette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C (1984) A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 105:10–14CrossRef
33.
go back to reference Villa MP, Rizzoli A, Miano S, Malagola C (2011) Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath 15:179–184PubMedCrossRef Villa MP, Rizzoli A, Miano S, Malagola C (2011) Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath 15:179–184PubMedCrossRef
34.
go back to reference Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, Gozal D (2010) Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 182:676–683PubMedCrossRef Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, Gozal D (2010) Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 182:676–683PubMedCrossRef
35.
go back to reference Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D (2008) Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 5:274–582PubMedCrossRef Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D (2008) Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 5:274–582PubMedCrossRef
36.
go back to reference Katz ES, D’Ambrosio CM (2010) Pediatric obstructive sleep apnea syndrome. Clin Chest Med 31:221–234PubMedCrossRef Katz ES, D’Ambrosio CM (2010) Pediatric obstructive sleep apnea syndrome. Clin Chest Med 31:221–234PubMedCrossRef
37.
go back to reference Guilleminault C, Huang YS, Glamann C, Li K, Chan A (2007) Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg 136:169–175PubMedCrossRef Guilleminault C, Huang YS, Glamann C, Li K, Chan A (2007) Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg 136:169–175PubMedCrossRef
38.
go back to reference Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009) Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 179:962–966PubMedCrossRef Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009) Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 179:962–966PubMedCrossRef
Metadata
Title
Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome
Authors
Maria Pia Villa
Silvia Miano
Alessandra Rizzoli
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Sleep and Breathing / Issue 4/2012
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-011-0595-9

Other articles of this Issue 4/2012

Sleep and Breathing 4/2012 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.