Functional Appliances in the Treatment of Sleep Apnea in Children

OSA has a negative impact on child growth, affecting their quality of life. If the condition persists, it may affects the quality of life in their adulthood. Tonsil hypertrophy is considered the leading cause of OSA and tonsillar removal is the optional treatment. Common diseases such as oral breathing and primary snoring are related to OSA and if there is an association with craniofacial abnormalities, this may lead to the recurrence of the OSA after adenotonsillectomy. The literature showed the most frequent complaints of patients with OSA were PS and troubled sleep. Allergic rhinitis RA was the most frequent comorbidity accompanying OSA, followed by hypertrophy of the tonsils. The most severe apnea indexes were found in younger children, and African descendants had a higher prevalence of the disease. One study reported that the tonsillectomy surgery was effective for the treatment of OSA in a group of children aged between 3 to 6 years old, who returned to a normal growth pattern. On the other hand, other studies reported that adolescents aged between 11 and 14 years old, continued with OB after the removal of the tonsils, presented the worst AHI and reduction of UA lumen. The causal effect between tonsil hypertrophy and OSA has not been established yet.

Treatments for persistent apnea are not completely known yet. Treatment approaches must be better evaluated. Anti-inflammatory therapies, masks for ventilation and oral appliances are offered to the treatment of recurrent OSA but the disease remains a challenge due to its multifactorial nature. Some authors consider as the best form of clinical treatment of OSA the use of CPAP or BPAP but such treatment does not get a good patients cooperation and the discontinuance is large.

Two reports of clinical case studies demonstrated OSA improvement with the use of FA. In both studies, high AHI were reported, but the patients did not have tonsillar hypertrophy and craniofacial deformities were treated with FA. The treatment improved the OSA and normalized the craniofacial deformities. Reports of clinical cases do not represent a high level of evidence and do not show statistical significance, but can be considered a warning about the clinical need of new approaches. Isolated cases, out of average, should be considered for further investigation. Early intervention of the orthodontist with FA in patients with disorders of the craniofacial structures in cooperation with other specialists should be considered. The FA promotes an increase in mandibular growth and permanently changes in the craniofacial structure, facilitating the breathing mode and preventing obstructions of the UA.Orthodontists are professionals trained to recognize and treat OSA with FA in patients with craniofacial anomalies promoting a harmonious facial growth and avoid aggressive surgery in adulthood and cardiovascular comorbidities resulting from sleep disorders