title: Midfacial and Dental Changes Associated with Nasal Positive Airway Pressure in Children with Obstructive Sleep Apnea and Craniofacial Conditions.
abstract: OBJECTIVE
  Nasal positive airway pressure (nPAP) for treatment of pediatric obstructive sleep apnea (OSA) is a widespread therapy that currently lacks longitudinal data describing how mask pressure impacts the developing facial skeleton. This retrospective cohort study compared midfacial growth in pediatric patients with underlying craniofacial conditions diagnosed with OSA who were compliant vs. noncompliant with nPAP therapy, and explored correlations between demographic, medical, and sleep variables with annual rate of facial change.
  
  
  METHODS
  Records from Seattle Children's Hospital's Craniofacial Center and Sleep Disorders Center were reviewed to identify patients prescribed nPAP for OSA with serial cephalographic images obtained during routine clinical care for concomitant craniofacial diagnosis. Lateral cephalometric analysis was used to determine mean annual change in midfacial structures from T1 (pre-nPAP) to T2 (post-nPAP) in compliant vs. noncompliant subjects. Compliance was indicated by nPAP usage of > 20 h/week for > 6 months.
  
  
  RESULTS
  50 subjects were compliant with nPAP therapy (mean age 10.42 years) for an average of 2.57 years, and 50 subjects were noncompliant (mean age 8.53 years). Compliant subjects experienced negative mean annual change (retrusion) of the midface compared to forward growth seen in noncompliant subjects (SNA: -0.57° vs. 0.56°), counterclockwise rotation of palatal plane (SN-PP: -1.15° vs. 0.09°), and upper incisor flaring (U1-SN: 2.41° vs. -0.51°).
  
  
  CONCLUSIONS
  Pressure to the midface from compliant nPAP use may alter normal facial growth. Cephalometric findings indicate a greater need for collaboration between sleep medicine physicians and orthodontists to monitor midfacial growth during nPAP treatment.
authors.affiliation: Craniofacial Orthodontics, Seattle Children's Hospital, Seattle, WA.
authors.forename: Soleil D
authors.initials: SD
authors.lastname: Roberts
authors.affiliation: Craniofacial Orthodontics, Seattle Children's Hospital, Seattle, WA.|University of Washington Department of Orthodontics, Seattle, WA.
authors.forename: Hitesh
authors.initials: H
authors.lastname: Kapadia
authors.affiliation: Craniofacial Orthodontics, Seattle Children's Hospital, Seattle, WA.|University of Washington Department of Orthodontics, Seattle, WA.
authors.forename: Geoff
authors.initials: G
authors.lastname: Greenlee
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.|Pediatric Sleep Disorders Center, Seattle Children's Hospital, Seattle, WA.
authors.forename: Maida L
authors.initials: ML
authors.lastname: Chen
mesh_terms: D002508:Cephalometry / Q000706:statistics & numerical data*; D002648:Child; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods*; D005147:Facial Bones / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008397:Masks / Q000009:adverse effects*; D008445:Maxillofacial Development; D009055:Mouth / Q000473:pathology*; D009296:Nasal Cavity; D010349:Patient Compliance; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
keywords: adolescent; airway obstruction; cephalometry; dentition; masks; obstructive; retrospective studies; sleep; sleep apnea; sleep disorders; snoring