Sleep Disordered Breathing
Sleep Disordered Breathing
Sleep disordered breathing is a relatively new area of study in medicine. As usual in a new area of study, there is little high evidence available to fully understand sleep disordered breathing etiologies, as well as different treatment’s effectiveness. Sleep disordered breathing can improve without treatment but more time, so without a control sample, one must be careful in how they interpret study results. The American Journal of Orthodontics did a deep dive into sleep disordered breathing and published their results in 2019. They found that orthodontics, as well as extractions in orthodontic treatment, did not have a statistical impact positively or negatively on sleep disordered breathing. However, more research is being done in this area so we must continually reassess. There are many case reports of orthodontic treatment, especially treatment with an expander, that seemed to improve or even cured sleep disordered breathing.
A sleep study is a gold standard in diagnosis of sleep disordered breathing. A clinical exam that includes the tongue and tonsils can be helpful. A 3D radiograph such as a CBCT is also helpful because it can show airway volume at one point in time. However, that is an incomplete picture. A narrow airway does not necessarily result in obstructive sleep apnea, rather it is the inability for the patient’s airway muscles to compensate adequately, possible due to poor neuromuscular tone.
We use the Pediatric Sleep Questionnaire to indicate if the patient likely struggles with sleep disordered breathing. This has a positive predictive value of 0.4 and a negative predictive value of 0.99 if the patient indicates 8 positive responses. This questionnaire includes questions about sleep, mouth breathing and snoring, but also about health, weight and behavior. Pediatric patients with sleep disordered breathing tend to not seem to listen when spoken to directly, have difficulty organizing tasks, is easily distracted by extraneous stimuli, fidgets, is overactive and interrupts others.
Orthodontic treatments that increase upper airway space may decrease sleep disordered breathing. With increased upper airway space, the tongue is able to fit better in the roof of the mouth, which allows the mouth to close more easily, which encourages nasal breathing. Mouth breathing is associated with sleep disordered breathing. We can increase the upper airway space with expanders, braces and aligners so it is important to know if a patient has sleep disordered breathing when treatment planning their case. If a patient has a narrow upper jaw, or an overbite, orthodontic treatment will likely increase the upper airway volume, so for these patients orthodontic treatment has more potential to decrease sleep disordered breathing.
Sleep disordered breathing has significant impacts on a patient’s overall health, so it is important to address this condition. One of the primary goals for a patient is to nasal breathe. Primary care doctors, pulmonologists, ear nose and throat doctors, myofunctional therapists, oral surgeons and sleep doctors all may be involved in a patient’s treatment. Some medical approaches can include, but are not limited to, tonsil and adenoid removal, nasal turbinate reduction, septum correction, weight reduction management, CPAP therapy, genioplasty, neurological and hormonal treatment and myofunctional therapy,