Comparison of the Effectiveness of Orthodontic Treatment with Adenotonsillectomy Procedures in Children with Obstructive Sleep Apnea (OSA)

H. Achmad
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Abstract

Background: Obstructive Sleep Apnea Syndrome (OSA) is a syndrome of total or partial obstruction of the airways, leading to significant disturbances with varying clinical impact. In children, the main cause is thought to be overgrowth (hypertrophy) of the tonsils and adenoids, as well as structural abnormalities in Pierre Robin and Down Syndrome. The airway structures are significantly narrowed in children with head-face bone abnormalities or craniofacial anomalies, causing them to experience airway obstruction even in the absence of adenoid hypertrophy. The incidence of OSA in children needs to be observed as well as rising risk factors such as obesity. Pediatric obstructive sleep apnea (OSA) is typically treated with an adenotonsillectomy and the use of orthodontic procedures including rapid maxillary expansion and mandibular advancement devices. Each approach has different treatment advantages. Systematic reviews and meta-analysis of OSA treatments have been reported, however there have been relatively few comparisons of various treatments. In a systematic review of the evidence for the efficacy of AT and orthodontic treatment, Templier et al. concluded that combined AT orthodontic treatment (RME and/or MAD) was more effective than either therapy alone for treating OSA in pediatric patients. Objective: To systemically analyze the literature on the effectiveness of orthodontic treatment with adenotonsillectomy surgery in children with obstructive sleep apnea (OSA) and to identify differences in the two treatments’ effectiveness. Conclusion and implications: The effectiveness of adenotonsillectomy, orthodontic treatment, and orthodontic treatment combined with adenotonsillectomy was assessed in children with mild OSA and mandibular retrognathia. That study, which needed a large sample size (352 children) and had a high dropout rate, revealed that combine orthodontic adenotonsillectomy (RME and/or MAD treatment) was more effective when given simultaneously than when given individually for treating OSA in pediatric patients. To date, the effectiveness of these two treatments cannot currently be compared due to a lack of strong evidence. If the treatment outcomes were unsatisfactory at 7 months after the initial treatment, subjects could receive further treatment following assessment by a stomatologist and ear, nose, and throat (ENT) specialist. Limitations: Of the 10 publications included in this review, 8 were randomized controlled trials, the remaining 2 non-randomized research journals were vulnerable to many biases that impair the certainty of the evidence gained, especially by confounding factors and the lack of control groups.
正畸治疗与腺扁桃体切除术治疗阻塞性睡眠呼吸暂停(OSA)患儿的疗效比较
背景:阻塞性睡眠呼吸暂停综合征(OSA)是一种气道完全或部分阻塞的综合征,可导致不同临床影响的严重障碍。在儿童中,主要原因被认为是扁桃体和腺样体过度生长(肥大),以及Pierre Robin和唐氏综合症的结构异常。头面部骨骼异常或颅面异常儿童的气道结构明显变窄,即使在没有腺样体肥大的情况下,也会导致气道阻塞。需要观察儿童OSA的发病率以及肥胖等风险因素的增加。儿童阻塞性睡眠呼吸暂停(OSA)通常通过腺扁桃体切除术和使用正畸程序进行治疗,包括快速上颌扩张和下颌前移装置。每种方法都有不同的治疗优势。OSA治疗的系统综述和荟萃分析已有报道,但对各种治疗的比较相对较少。在对AT和正畸治疗疗效证据的系统综述中,Templier等人得出结论,在治疗儿童OSA方面,联合AT正畸治疗(RME和/或MAD)比单独治疗更有效。目的:系统分析腺扁桃体切除术正畸治疗儿童阻塞性睡眠呼吸暂停(OSA)的疗效文献,并确定两种治疗方法的疗效差异。结论和意义:评估了腺扁桃体切除术、正畸治疗以及正畸治疗结合腺扁桃体切除术治疗轻度OSA和下颌后颚症的有效性。这项研究需要大样本量(352名儿童),并且辍学率很高。研究表明,在治疗儿童OSA时,同时给予正畸腺扁桃体切除术(RME和/或MAD治疗)比单独给予更有效。到目前为止,由于缺乏强有力的证据,这两种治疗方法的有效性目前无法进行比较。如果在初次治疗后7个月治疗结果不令人满意,受试者可以在口腔医生和耳鼻喉(ENT)专家的评估后接受进一步治疗。局限性:在这篇综述中包括的10篇出版物中,8篇是随机对照试验,其余2篇非随机研究期刊容易受到许多偏见的影响,这些偏见损害了所获得证据的确定性,特别是由于混杂因素和缺乏对照组。
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