Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences

Abstract

Aims: Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese children.

Method: Review of experimental data from infant monkeys with experimentally induced nasal resistance. Review of early historical data in the orthodontic literature indicating the abnormal oral-facial development associated with mouth breathing and nasal resistance. Review of the progressive demonstration of sleep-disordered-breathing (SDB) in children who underwent incomplete treatment of OSA with adenotonsillectomy, and demonstration of abnormal oral-facial anatomy that must often be treated in order for the resolution of OSA. Review of data of long-term recurrence of OSA and indication of oral-facial myofunctional dysfunction in association with the recurrence of OSA.

Results: Presentation of prospective data on premature infants and SDB-treated children, supporting the concept of oral-facial hypotonia. Presentation of evidence supporting hypotonia as a primary element in the development of oral-facial anatomic abnormalities leading to abnormal breathing during sleep. Continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB. Role of myofunctional reeducation with orthodontics and elimination of upper airway soft tissue in the treatment of non-obese SDB children.

Conclusion: Pediatric OSA in non-obese children is a disorder of oral-facial growth.

Keywords: hypotonia; non-obese; oral-facial anatomy; oral-facial growth; oral-facial myofunctional dysfunction; pediatric sleep-disordered-breathing.