Update on Current Knowledge of Paediatric Obstructive Sleep Apnoea: From Animal to Human Studies.

Abstract

Orthodontists' interest in paediatric obstructive sleep apnoea (PedOSA) has grown in popularity recently. We have seen growth modification treatment modalities, including maxillary expansion, promising the prevention or cure of PedOSA. Clinical approaches such as palatal expansion and mandibular and maxillary complex advancement have been proposed to manage PedOSA. These hypotheses should be adequately tested before clinical recommendations are formulated. This review aimed to narratively synthesise our current understanding of PedOSA management with craniofacial growth modification alternatives. Basic research on the biological basis of PedOSA has been conducted in animal models. Laboratory-based PedOSA studies wish to provide insight into the molecular biological mechanisms by which human PedOSA affects growth-associated structural and emotional growth and development. In the proposed IH animal model, mandibular growth (especially posterior anteroposterior and transverse dimensions) and condylar head bone density were more sensitive to IH exposure in adolescents but less in juvenile rats. Nevertheless, clear-cut statistical growth differences were limited. This suggests that IH, in this rat model, influenced mandibular morphology and metabolism later than earlier craniofacial growth stages. No impact was found for the maxillofacial complex in any plane of space. The existing human studies on the causes, risk factors, consequences, symptomatology, diagnosis and effects of PedOSA are discussed. However, there is a pressing need for further research to clarify whether craniofacial disturbances are consequences or facilitators of PedOSA. Several hypotheses about the potential impact of impaired craniofacial growth as a facilitator for PedOSA currently circulate.