The diagnosis of sleep apnea is based on the conjoint evaluation of clinical symptoms (e.g. excessive daytime sleepiness and fatigue) and of the results of a formal sleep study (polysomnography, or reduced channels home based test). The latter aims at establishing an "objective" diagnosis indicator linked to the quantity of apneic events per hour of sleep (Apnea Hypopnea Index(AHI), or Respiratory Disturbance Index (RDI)), associated to a formal threshold, above which a patient is considered as suffering from sleep apnea, and the severity of their sleep apnea can then be quantified.
Nevertheless, due to the number and variability in the actual symptoms and nature of apneic events (e.g., hypopnea vs apnea, central vs obstructive), the variability of patients' physiologies, and the intrinsic imperfections of the experimental setups and methods, this field is opened to debate. Within this context, the definition of an apneic event depends on several factors (e.g. patient's age) and account for this variability through a multi-criteria decision rule described in several, sometimes conflicting, guidelines. One example of a commonly adopted definition of an apnea (for an adult) includes a minimum 10 second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2) or a blood oxygen desaturation of 3–4% or greater, or both arousal and desaturation.
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, according to a study in the July 1 issue of the journal Sleep.
Children in the 30-month study were between the ages of five and nine years. They were referred to the Stanford Sleep Disorders Clinic for 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. In all participants symptoms improved but were not normalized, with no significant difference in the two treatment groups - except for the two children whose symptoms resolved after orthodontic expansion. The remaining 30 children then were treated with the second method followed by another polysomnogram and clinical evaluation.
Although the study achieved positive results, Guilleminault cautions that treating OSA in young children is complex, and more data is needed to formulate rules for decision making.
"Pediatric sleep specialists need to work not only in collaboration with ear, nose, and throat surgeons; but also with orthodontists," Guilleminault said. "Pediatric orthodontists should learn what can be done to help the sleep specialist obtain better results in treating obstructive sleep apnea in children."
