Managing Snoring and Sleep Apnea: What Works for Kids and Adults
At the American Academy of Dental Sleep Medicine’s conference, July 2024, 12 experts, reviewed therapies used to manage and treat OSA and snoring to determine if they prevent, manage or cure the disorder. Dr. Rose Sheats UNC reported the findings. The potential risk factors for OSA and snoring are malocclusion, intraoral tethered tissue, tongue dysfunction, soft tissue anatomy and physiology. To these, I, Dr. Harrison, would add another important 6th factor; breathing disorders which have a high correlation if not causation of the five areas studied. Functional breathing must get more attention from the medical/dental community. Life and health are all about the body’s balance of 02 and C02. Cures exist for children, much less so for adults. Why allow dysfunction to continue into adulthood?
Appliances used were customized functional fixed or removable to expand the maxilla and advance the mandible and prefabricated myofunctional appliances to guide growth and development over time. Myofunctional therapy uses no appliance, instead, trains and strengthens orofacial musculature. Tethered tissue release was viewed with some caution which surprised me, because a tongue tie prevents breast feeding and proper tongue posture and function, this I know for certain. The panel supported all the research that proves that extraction of premolars for orthodontic treatment has no bearing on OSA or snoring as has been claimed by a return of radical, fringe orthodontists who mistakenly believe that God meant for us to have 32 perfectly aligned teeth, so you orthodontists somehow better get all of them to fit on jaws too small with insufficient bone and soft tissue support into a perfect bite. Pure nonsense and proven to be a false assumption.
Pediatric OSA shows up 5% of age 2-8 population. Unfavorable anatomical features correlate but caution is necessary not to assume that correcting them prevents or cures OSA. Removal of tonsils and adenoids has become the first line therapy but must be followed by correcting dysfunctional mouth breathing or else snoring and OSA returns. Why not prevent the tonsils and adenoids from becoming inflamed instead of surgery? Snoring, dysfunctional breathing, when prevalent in children is associated with bed wetting and sleep fragmentation which leads to learning and behavior compromise. The cause of snoring, young or old, should be investigated because it can be successfully eliminated and is the first step for OSA improvement.
Unfortunately, “scientific” reporting is not always accurate and subject to marketing manipulation. AHI is an imperfect measure as is CBCT analysis of airway volume. Random controlled studies with a large sample size are difficult and expensive to obtain and there is uncertainty in identifying responders and partial responders. Treatment in children 2-4 is problematic for many reasons and was voted as uncertain and not appropriate by the panel of experts. I think they missed something.
It is noteworthy that over 40% of children studied self-improved with no therapy other than watchful waiting which would be categorically regarded as supervised neglect by orthodontic and pediatric early treatment promoters. Insufficient evidence does not mean no evidence, discovering scientific truth is difficult and more evidence will always be needed, but correction of a dysfunctional or aberrant anatomy as early as possible does bend our thinking to come to the rescue and normalize function and structure. Best we talk about these issues and improve our understanding.
John B. Harrison DDS,MSc
