CURRENT TREATMENT METHODS
Obstructive sleep apnea (OSA) in children is a serious problem. ADHD, enuresis, failure to thrive, learning, cognitive and behavioral disorders, disrupted sleep and cardiovascular problems are some of the comorbid symptoms of OSA. Children with OSA generate 2.6 times the amount of healthcare expenses as non-OSA children.
Adenotonsillectomy is the first line of treatment. Surgery has an 80% reported success rate one year later. Adenotonsillectomy is both an invasive and very painful procedure. There is a significant rate of OSA relapse in subsequent years if the attendant problems such as open mouth, low tongue posture, dysphagia and malocclusions are not corrected.
Continuous positive airway pressure (CPAP) is commonly used as the second tier treatment modality for pediatric OSA. The long term use of CPAP, with its face mask is usually effective, but cumbersome, uncomfortable and has low compliance. At some point it must be recognized that many of these kids have a facial development problem. Midface hypoplasia, small mouths and crowded teeth, is a particularly undesirable consequence because it becomes a perpetuating factor for OSA in later years. CPAP is not currently approved by the FDA for use on children less than seven years of age. Pediatricians are in need of better treatment methods.
A multidisciplinary clinical protocol involving surgery, allergy treatment, orthodontic expansion, and oral myofunctional therapy as treatment of sleep apnea in children having deciduous dentition is being suggested. This protocol is based on sound biologic and physiologic principles, logical multidisciplinary theories, reasonable scientific rationale, a significant number of medical publications reporting clinical success and in clinical practice “it works” and there is excellent evidence that the singular use of any modality has serious shortcomings.