Malocclusion in Pediatric Obstructive Sleep Apnea Refractory to Adenotonsillectomy Referred for Sleep Study

Thesis (Master's)--University of Washington, 2020Introduction: The sequelae of untreated pediatric Obstructive Sleep Apnea (OSA) are serious, however, its treatment is not always evident. The first line treatment of pediatric OSA is adenotonsillectomy, but this is not successful in all. It is plausible that underlying dentofacial characteristics are associated with those who have refractory OSA despite adenotonsillectomy. Should certain dentofacial findings be prevalent in those with refractory OSA, this may represent a point of early identification and intervention for OSA. Objective: The aims of this study were to describe dentofacial characteristics (overjet, overbite, posterior crossbite, facial convexity) in children referred to a tertiary pediatric sleep center for OSA. Amongst those subjects, comparisons were made between groups based on surgical status (naïve vs adenotonsillectomy), severity of OSA (none, mild, moderate, severe), and with general population control data available from the third National Health and Nutrition Examination Survey (NHANES III). Methods: Subjects were recruited from Seattle Children’s Hospital Sleep Center at Overlake. Subject profile photo, intraoral examination, and dental history questionnaire were recorded. Intraoral examination consisted of Angle classification, overjet, overbite, and posterior crossbite presence. The obstructive Apnea-Hypopnea Index (oAHI) was obtained from the sleep study results. Univariate analysis was used to evaluate how oAHI severity varies with overjet, overbite, posterior crossbite, and facial convexity based on exposure to prior adenotonsillectomy. Results: 95 subjects were enrolled in this study. 26 subjects had prior adenotosillectomy surgery and 69 subjects were surgically naïve. 21 subjects were diagnosed with no OSA, 54 subjects diagnosed with mild OSA, and 20 subjects were diagnosed with moderate to severe OSA. No statistically significant differences in dentofacial characteristics were found between the subjects who had prior adenotonsillectomy compared to the surgically naïve group. Facial convexity of the Moderate to Severe OSA group showed a statistically significant difference (P=0.02) when compared to the No OSA group however this may be caused by the confounding variable of obesity. All other dentofacial characteristics exhibited no statistically significant difference between the OSA severity groups. Comparison with the NHANES III population data showed a significant increase in posterior crossbite in 8-11 years old patients with Mild and Moderate to Severe OSA. Conclusion: There were no significant differences in the dentofacial characteristics between the children who had prior adonetosillectomy and those who were surgically naïve. There were some dentofacial differences between the children in different OSA severity groups (facial convexity and posterior crossbite), however due to the small sample size and confounding variables these findings may be spurious