Facial Patterns and Obstructive Sleep Apnea in Children Seeking for Orthodontic Treatment: Data From 3671 Polysomnographic Recordings

Abstract

Aim: To evaluate the association between vertical and sagittal facial profile characteristics and the diagnosis/severity of Obstructive Sleep Apnea (OSA) based on hospital-based polysomnography (PSG) in children attending their first orthodontic visit. Materials and Methods: 3671 children aged 7 to 9 years who attended a private practice for a first orthodontic consultation were included. Apnea/Hypopnea Index (AHI) was measured from PSG, while vertical and skeletal facial profile characteristics were assessed according to the Modified Sassouni Analysis on lateral cephalogram. Analysis of Variance (ANOVA) was used to compare sagittal and vertical patterns among patient subgroups divided according to AHI (AHI = 0, AHI 1–3, AHI 4–5, AHI 6–10, AHI ≥ 11). Results: No statistically significant difference was found in the AHI according to gender (p = 0.84) and age (p = 0.61). It was observed that 87.3% of children with AHI ≥ 11 had a long facial pattern, whereas those with low AHI values (AHI = 0 or 1 ≤ AHI ≤ 3) were mostly classified as having a normal vertical pattern (p < 0.001). Furthermore, children with AHI ≥ 11 presented with a Class II facial profile or maxillomandibular retrusion, while children with maxillomandibular protrusion and a Class I profile had lower AHI values (AHI = 0 or 1 ≤ AHI ≤ 3, p < 0.001). Conclusions: Class II profile, maxillomandibular retrusion, and increased anterior lower facial height are highly present in severe OSA children between the ages of 7 to 9 years. Therefore, orthodontists are encouraged to consider the possibility of breathing issues in children presenting with such craniofacial features.