Childhood obstructive sleep apnea syndrome: an interdisciplinary approach: a prospective epidemiological study of 4,318 five-and-a-half-year-old children.

UNLABELLED: Population-representative data on sleep disorders in children is scarce. BACKGROUND AND OBJECTIVE: The aim of this epidemiological study was to determine the prevalence of various sleep-related breathing disorders (SRBD) and any correlations with occlusion and jaw abnormalities in preschool children. MATERIALS AND METHODS: The study material consisted of 4,318 children (5.5 years old) whose parents completed the Pediatric Sleep Questionnaire (PSQ); 60 out of 140 children (6.3 ± 0.78 years old) with a positive questionnaire score (> 0.33) were examined by an orthodontist and ENT specialist. From this cohort, 15 children who presented a dental occlusion and jaw abnormality but no indication for surgical reduction of adenotonsillar tissue underwent polysomnography in a sleep laboratory. RESULTS: According to the PSQ, 3.3% of the 5.5-year-olds showed evidence of a SRBD. Boys were affected significantly more frequently. Lack of concentration, hyperactivity, morning fatigue, mouth breathing, loud snoring, and breathing interruptions were indicators of SRBD. The SRBD children more frequently presented with jaw abnormalities such as mandibular retrognathia, lateral cross-bite, and increased overjet. The SRBD cohort showed a higher rate of orofacial dysfunctions. Adenotonsillar hyperplasia still played a significant role in the development of SRBD. CONCLUSION: In contrast to previous reports in the literature, the frequency of SRBD in our group of 5- to 6-year-olds was lower (3%). Boys with adenotonsillar hyperplasia and/or mandibular retrognathia, lateral cross bite, and an enlarged overjet require special attention.

An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome.

BACKGROUND: For the treatment of nonsevere obstructive sleep apnea syndrome (OSAS), mandibular advancement devices (MADs) are employed as an alternative to nasal continuous positive airway pressure (CPAP) therapy. However, very few specific data on the effectiveness of MADs in this group of patients are available. We therefore compared an individually adjustable intraoral sleep apnea device (ISAD) that permits movements of the lower jaw in three dimensions, with CPAP in the treatment of patients with an apnea/hypopnea index (AHI) < or = 30/h. METHODS: In a randomized crossover study, 16 men and 4 women (mean +/- SD age, 56.5 +/- 10.2 years; body mass index, 31.2 +/- 6.4; AHI, 17.5 +/- 7.7/h) were treated for 6 weeks with each modality. RESULTS: In the initial phase, a significant improvement in AHI (baseline, 17.5 +/- 7.7/h; ISAD, 10.5 +/- 7.5/h [p < 0.05]; CPAP, 3.5 +/- 2.9/h [p < 0.01]) and in breathing-related arousals (baseline, 8.9 +/- 6.1/h; ISAD, 3.7 +/- 3.3/h [p < 0.01]; CPAP, 1.4 +/- 1.6/h [p < 0.01]) was achieved with both modalities. Considering all 20 subjects, after 6 weeks of treatment, normalization of the respiratory parameters was seen only with CPAP. However, 30% of the patients had a lasting reduction in AHI to < 10/h with the ISAD also. The patients considered the ISAD to be easier to use (scale of 1 to 6: ISAD, 1.8 +/- 1.1; CPAP, 3.1 +/- 1.5 [p < 0.05]), and indicated greater utilization of the device in comparison with CPAP. CONCLUSION: Even in patients with mild-to-moderate OSAS, CPAP is the more effective long-term treatment modality. In the individual case, the better compliance seen with the ISAD may be advantageous.