Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences.
OBJECTIVE
Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese children.


METHODS
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.


CONCLUSIONS
Pediatric OSA in non-obese children is a disorder of oral-facial growth.
Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University Taiwan, China.
Yu-Shu
YS
Huang
Christian
C
Guilleminault
hypotonia; non-obese; oral-facial anatomy; oral-facial growth; oral-facial myofunctional dysfunction; pediatric sleep-disordered-breathing