EFFECTIVENESS OF ORTHODONTIC TREATMENT WITH PREFABRICATED MYOFUNCTIONAL APPLIANCES IN CHILDREN WITH SLEEP-RELATED BREATHING DISORDERS AND OBSTRUCTIVE SLEEP APNEA: AN 18-MONTH FOLLOW-UP

Sleep-Related Breathing Disorders (SRBD) include various clinical entities, from primary snoring to Obstructive Sleep Apnea Syndrome (OSAS). They are characterized by intermittent partial or complete (hypopnea/apnea) upper airway obstruction during sleep which lead to sleep disturbance, cardio-respiratory, and neuro-behavioral impairments. Malocclusion and oral-facial dysfunctions such as having a retrusive bite, narrow maxilla, mandibular hypoplasia, oral breathing, or visceral swallowing are considered risk factors for SRBD and OSAS in pre-schoolers. The present study aims to assess the effectiveness of orthodontic treatment in childhood SRBD and the changes which occur in oral functions and cranio-facial structures. Participants were recruited if they were less than 6 years of age, presented signs and symptoms of SRBD together with malocclusion and/or oral dysfunctions, and had a baseline apnea index < 5 event/h. Children were assigned to a 12-month treatment with a preformed myofunctional appliance (EFline\uae, Orthoplus), then to an additional 6-month retention period. At baseline, all children underwent physical examination, orthodontic assessment, nocturnal polygraphy, lateral cephalograms and dental casts. A 6-month nocturnal polygraphy was performed only in OSAS patients. Validated tools for assessing risk of SRBD and OSAS (Sleep Clinical Score, SCS), frequency of sleep disturbances (Sleep Disturbances Scale for Children, SDSC) and neuro-behavioral impairment (Child Behavior Checklist, CBCL) were performed at baseline (T0) and after 12 months (T1). Custom cephalometric analyses and dental arch width measurements were digitally performed at baseline and after 18 months (T2). Of the 12 patients initially recruited (4 females, 8 males; mean age 5.0\ub10.47 years), one child dropped-out. Overall, children tolerated the treatment well and recovered from oral dysfunctions (p<0.001). The OSAS subgroup completely recovered from apnea (AHI<1). Significant improvements were seen in respiratory, sleep and dento-skeletal variables: mean SCS (p<0.001), SDSC and CBCL (p<0.01) scores decreased after 12 months; a mean increase of 2-3 mm occurred in pharyngeal airway widths (p<0.01) and 6 mm in mandibular length (p<0.001), a less hyperdivergent facial growth pattern and favourable advancement of the hyoid bone occurred; mean inter-canine widths increased by 2.3-3 mm in the mandible (p<0.001) and in the maxilla (p<0.05). No significant differences were detected between OSAS and SRBD non-OSAS subgroups with the exception of the SCS and CBCL scores at baseline which were resolved after treatment. Orthodontic treatment with PMAs may produce significant improvements in respiratory and sleep patterns together with significant cranio-facial and dental changes. PMAs might be an effective tool in the multidisciplinary treatment of SRBD and mild-to-moderate OSAS in pre-schooled children