Pediatric Obstructive Sleep Apnea (OSA) and Sleep Disordered Breathing (SDB)

A team of orthodontists has developed a strategy to effectively implement treatment of obstructive sleep apnea into a practice and improve patients’ lives

Don’t let obstructive sleep patterns affect your child’s daily activities and well-being. Our sleep apnea and disorder professionals are here to restore the health of our youngest patients.

To the surprise of many parents, our initial evaluation includes a thorough assessment of your child’s facial development and its influence in airway constriction, sleep, and orthodontic conditions. Orthodontic treatment will not only prevent a developing orthodontic problem, but will also provide a very effective approach for the treatment of breathing as well as obstructive sleep disorders.

Obstructive sleep apnea (OSA) or sleep disordered breathing (SDB) may go largely unrecognized in children, but it must be noted that they can be the source of serious health implications. The most common causes of these breathing symptoms include:

  • Obstructive tissues – enlarged tonsils and/or adenoids
  • Narrow jaws – constriction of the oral cavity and airways
  • Retrusive lower jaw
  • Resting tongue position

Does my child suffer with OSA or SDB?

Signs that your child could be suffering from a sleep disorder include, but are not limited to, morning fatigue or behavioral problems at school such as ADD or ADHD. Children suffering with sleep disturbances are often smaller as they lack vital growth hormone production. They may have long narrow faces and/or a bluish hue under the eyes due to oxygen deprivation. Other common symptoms include:

  • Difficulty awakening from sleep
  • Mouth or noisy breathing
  • Trouble concentrating at school
  • Chronic daytime sleepiness
  • Frequent upper airway infections
  • Snoring or loud breathing noise when sleeping
  • Increased sweating at night
  • Bedwetting
  • Restless sleep

Pediatric Epworth Sleepiness Scale (Ages 6-16)

The Epworth Sleepiness Scale (ESS) is a great aid in evaluating obstructive sleep patterns in children. Read the following situations and use the scale provided to rate your child’s sleepiness. A score of 10 or more is considered sleepy and requires further testing to determine sleep apnea by a sleep specialist.

  • 0 = would never doze
  • 1 = slight chance of dozing
  • 2 = moderate chance of dozing
  • 3 = high chance of dozing

How does orthodontic treatment help?

If an evaluation indicates that your child is suffering from sleep disordered breathing, we will work with your pediatrician, ENT, allergist, and sleep specialist to determine the most appropriate treatment. In many cases, orthodontic treatment to widen the upper jaw (palate expansion) will correct deformities common with chronic nasal obstruction. Research confirms measured increases in nasal volume for 100% of patients receiving this expansion procedure. Approximately 40% of patients may require Adenotonsillectomy (removal of the tonsils and adenoids) to fully resolve OSA or SDB.

What is palate expansion?

Expansion of the palate (roof of the mouth) is performed when it is determined the upper jaw is too narrow. The palate is made up of two bones joined down the center with a junction called a “suture.” Prior to the age of 12, the palatal suture is made of stretchable cartilage where growth takes place (growth plate). Between the age of 12 and 16, the suture fuses and the roof of the mouth becomes a single solid structure.

Orthodontic expansion takes advantage of the presence of the palatal growth plate, utilizing an appliance to widen the upper jaw. The expansion procedure opens the airway to provide more oxygenation during sleep, creates more space for erupting permanent teeth, and provides good architecture for the growing face.

Palate Expansion - Before Palate Expansion - After

Orthodontic treatment may provide permanent treatment that may eliminate a need for sleep apnea treatment as adults. If your child exhibits any of the symptoms of sleep apnea or sleep disordered breathing, contact us to arrange a complimentary evaluation.

Cited References:
Xu Z (2013) Rapid Maxillary Expansion and Childhood Obstructive Sleep Apnea Syndrome. JSM Dent 1(2): 1010
The Wisconsin Cohort Study (1,522 subjects) documented up to a 35% reduction in 18-year life expectancy for severe apneics. Terry Young, PhD, Lauren Finn, MS, Paul E. Peppard, PhD, Mariana Szklo-Coxe, PhD, Diane Austin, MS, F. Javier Nieto, PhD, Robin Stubbs, BS, and K. Mae Hla, MD (Aug. 1, 2008.
Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort: Sleep, 31(8): 1071-1078.
Children with sleep breathing disorder symptoms suffer from behavioral problems and lower IQ scores.
Bonuck, PhD, Freeman, DrPH, Chervin, MD, MS, Xu, PhD, (March, 2012) Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years, American Academy of Otolaryngology – Head and Neck Surgery. New York’s Albert Einstein College of Medicine, Pediatrics, (doi: 10.1542/peds.2011-1402)
Children with sleep breathing disorder symptoms suffer from behavioral problems and lower IQ scores, (2006) Childhood Sleep Apnea Linked to Brain Damage, Lower IQ, Johns Hopkins Medicine
Hershey HG, Stewart BL, Warren DW. March 1976. Changes in nasal airway resistance associated with rapid maxillary expansion. Am J Orthod. 69(3);274-84
Baratieri C, Alves M Jr., de Souza MM, de Souza Araujo MT, Maia LC. August 2011. Does rapid maxillary expansion have long-term effects on airway dimensions and breathing? Am J Orthod Dentofacial Orthop. 140(2):146-56
Altug-Atac ATl, Atac MS, Jurt G, Karasud HA. February 2010, Epub 2009 December 29. Changes in nasal structures following orthopaedic and surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg. 39(2):129-35
Gorgulu S, Gokce SM, Olmez H, Sagdic D, Ors F. November 2011. Nasal cavity volume changes after rapid maxillary expansion in adolescents evaluated with 3-dimensional simulation and modeling programs.
Am J Orthod Dentofacial Orthop. 140(5):633-40
Smith T, Ghoneima A, Steart K, Liu S, Eckert G, Halum S, Kula K. May 2012. Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofacial Orthop 141(5):618-26.
Pirelli P, Saponara M, Guilleminault C. June 15 2004. Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep. 27;(4):761-6.
Villa MP, Malagola C, Pagani J, Montesano M, Rizzoli A, Guilleminault C, Ronchetti R. March 2007; Epub 2007 Jan 18. Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. Sleep Med. 8(2):128-34
Villa MP, Rizzoli A, Miano S, Malagola C. May 2011; Epub 2001 March 25. Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath. 15(2:179-84 


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