Treating Pediatric Sleep Apnea Requires Combined Methods

Treating pediatric obstructive sleep apnea (OSA) with either orthodontic expansion or adenotonsillectomy improves symptoms, but most young children need both treatments to have complete resolution of OSA symptoms, claims a new study.

Researchers at Stanford University School of Medicine (Palo Alto, CA, USA) conducted a study of 32 children between the ages of five and nine who were referred for treatment of symptoms such as snoring, disrupted sleep, daytime fatigue and abnormal amounts of movement during sleep. Participants were enrolled in the study after OSA was confirmed by overnight polysomnography, and after clinical evaluations determined that both treatments would be needed. Half of the children were treated first with adenotonsillectomy performed by an otolaryngologist, and half were treated first with orthodontic expansion using an appliance designed to be fixed to the teeth. After treatment, each child was monitored again by overnight polysomnography and evaluated in the clinic three to six months later. The children were then treated with the second method followed by another polysomnogram and clinical evaluation, except for two children whose symptoms resolved after orthodontic expansion alone.

The study results showed that in all participants symptoms improved but were not normalized, with no significant difference in the two treatment groups. All 32 children showed improvements after being treated with either oradenotonsillectomy or orthodontic expansion, but 28 of the participants needed both treatments for the symptoms of OSA to be eliminated. Two children had no more symptoms after being treated only with orthodontic expansion, and two other children continued to have symptoms after both treatments. The study was published in the July 1, 2008, issue of the journal Sleep.

"Usually physicians treat OSA by taking tonsils and adenoids out,” said lead author Professor Christian Guilleminault, M.D, a specialist in sleep medicine. "Often the upper airway is small due to the bones that make up the facial structure; this in itself limits the benefits of surgical elimination of tonsils and adenoids. The combination of two treatments - one of them is a special type of orthodontic treatment - will give better results than elimination of tonsils and adenoids alone.”

Pediatric OSA is a common form of sleep-disordered breathing that affects about two percent of young children; it often appears between the ages of three and six years when the tonsils and adenoids are large compared to the throat. OSA occurs when muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.


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Stanford University School of Medicine