Management of obstructive sleep apnea-hypopnea syndrome in children: what is the role of orthodontics? A scoping review.

Purpose: Obstructive sleep apnoea syndrome (OSAHS) is a respiratory disorder that greatly affects the health and quality of life of patients. OSAHS affects up to 5.7% of children aged up to 18 years old, and its prevalence is doubled in children with risk factors such as obesity, craniofacial syndromes, Prader-Willi syndrome or trisomy 21. The most common aetiology of OSAHS in children is tonsil hypertrophy, and the first line treatment proposed for the majority of patients is the surgical removal of these tonsils. However, the risk of residual OSAHS after surgery is approximately 10-20%, and, thus, other therapeutic options are being developed to improve patient care. The objective of this scoping review is to assess the extent of the evidence regarding the effectiveness of the different types of treatments offered for OSAHS in children.

Methods: Relevant studies over a 13 year period were identified using three search engines: PubMed, Scopus and Web of Science. The selection of studies was made using previously defined inclusion and exclusion criteria based on a review of the title and abstracts initially, followed by a full reading of the texts. The studies were classified based on their design and following the grades and level of scientific proof defined by the Health High Authority.

Results: Twenty-nine manuscripts were included for synthesis. The first-line treatment proposed for the majority of patients with OSAHS is surgical removal of the tonsils, but the risk of residual OSAHS after surgery remains significant, and other less invasive options, such as orthodontics, are also useful for improving the management of these patients.

Conclusion: OSAHS treatment recommendations should consider orthodontic treatment as a minimally invasive approach with beneficial effects.