Kids Shouldn't wait for help with Neurological Development
Awareness of sleep disordered breathing in the pediatric population is a priority for the ABCDSM
Even though we are all aware of the challenges of clinical equipoise in providing definitive treatment protocols for any patient population, the pediatric population has it's own complex considerations. However, these considerations are exponentially more important to consider because children are developing their bodies and brains while some are potentially being underserved by the healthcare provider who chooses to look the other way when treating a child who is not receiving the benefits of restorative sleep.
The Amercan Board of Craniofacial Dental Sleep Medicine welcomes providers who are passionate supporters of incorporating awareness and treatment for pediatric sleep disordered breathing.
Adults are simply children who have developed complex compensations for the neural circuits and structural form required for successful sleep architecture, metrics and quality of life.
The ABCDSM encourages providers to consider their responsibilities to their patients by valuing their epistemological responsibility to practice evidence based medicine considering the emerging research on the importance of neural circuits and pediatric development.
An epistemological shift: from evidence-based medicine to epistemological responsibility
Sophie van Baalen 1, Mieke Boon
https://pubmed.ncbi.nlm.nih.gov/25394168/
" Instead of deferring part of the professional responsibility to strict clinical guidelines, as EBM allows for, our alternative epistemology holds doctors accountable for epistemic considerations in clinical decision making towards the diagnosis and treatment plan of individual patients. One of the key intellectual challenges of doctors is the ability to bring together heterogeneous pieces of information to construct a coherent 'picture' of a specific patient. In the proposed epistemology, we consider this 'picture' as an epistemological tool that may then be employed in the diagnosis and treatment of a specific patient. "
Literature references for pediatric SBD and OSA
A roadmap of craniofacial growth modification for children with sleep-disordered breathing: a multidisciplinary proposal
Audrey Yoon, David Gozal, Clete Kushida, Rafael Pelayo, Stanley Liu, Jasmine Faldu, Christine Hong
"From infancy to adulthood the dentition and craniofacial complex change with growth patterns that can be intercepted and targeted at critical time points. This article proposes a clinical guideline for application of multidisciplinary care with emphasis on dentofacial interventions that target variable growth patterns."
Craniofacial Sleep Medicine: The Important Role of Dental Providers in Detecting and Treating Sleep Disordered Breathing in Children
by Tammarie Heit 1,Bea Janine Tablizo 2,Martina Salud 3ORCID,Fan Mo 4,Mandip Kang 4,Mary Anne Tablizo 4,5,6 andManisha Witmans 7,
https://www.mdpi.com/2227-9067/9/7/1057
"Dentists as well as primary care providers and/or pediatricians play a crucial role in screening for OSA as they often see the patient twice a year for an exam. In general, sleep-trained dentists are familiar and do play an active role, but general dentists may not. Non-sleep-trained dentists may not routinely screen for OSA yet, but it is encouraged by the American Dental Association."
Sleep-Disordered Breathing in Children
Kevin Gipson, MD, MS,† Mengdi Lu, MD,† and T. Bernard Kinane, MD†
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557418/
SUMMARY
"Based on strong research evidence and expert consensus, all children and adolescents should be screened for snoring and other signs and symptoms of sleep-disordered breathing.
Based on some research evidence as well as expert consensus, adenotonsillectomy is the first-line therapy for children and adolescents with obstructive sleep apnea in the context of adenotonsillar hypertrophy.
Based on expert consensus, in-laboratory sleep studies remain the gold standard for the diagnosis of sleep-disordered breathing in patients younger than 18 years. "
Sleep-disordered breathing in children: are we underestimating the problem?
R. B. Mitchell
https://erj.ersjournals.com/content/25/2/216
"The American Academy of Pediatrics (Elk Grove Village, IL, USA) recently published clinical practice guidelines on the diagnosis and management of childhood OSAS and emphasised the need to screen all children for snoring 13. Recent studies have shown that primary snoring, without OSAS, is not as “benign” as was first thought and is also associated with behavioural and cognitive problems, including reduced verbal and global intelligence quotient scores, reduced attention and memory deficits"
Risk Factors for Sleep-disordered Breathing in Children
Associations with Obesity, Race, and Respiratory Problems
SUSAN REDLINE , PETER V. TISHLER , MARK SCHLUCHTER , JOAN AYLOR , KATHRYN CLARK , and GREGORY GRAHAM
https://www.atsjournals.org/doi/10.1164/ajrccm.159.5.9809079
"Even mild forms of SDB may be important in children, who may be particularly susceptible to adverse effects of sleep disruption and gas exchange abnormalities that may negatively impact growth and development. The findings from this study identify several risk factors for SDB in children, highlighting risk associated with obesity, African American race, and respiratory problems. Further understanding how these risk factors negatively impact upper airway patency may aid in elucidating the pathogenesis of SDB and optimizing treatment strategies."
Orofacial dysfunction screening examinations in children with sleep-disordered breathing symptoms
Dao Anh Hoang 1 2, Van Nhat Thang Le 3, Tam Minh Nguyen 4, Triin Jagomägi 2
https://pubmed.ncbi.nlm.nih.gov/37408343/
"Abnormal breathing patterns (22.4%) demonstrated lower posterior tongue mobility and lower muscle strength. Daytime sleepiness symptoms were associated with changes in muscle strength, facial appearance, and impaired orofacial function. Lower strengths of lip and tongue or improper nasal breathing were more likely to be present in children with reported sleep apnea (6.6%). Neurobehavioral symptoms of inattention and hyperactivity were linked to anomalous appearance/posture, increases in tongue mobility and oral strength. This study demonstrates a prevalence of orofacial myofunctional anomalies in children exhibiting SDB symptoms. Children with prominent SDB symptoms should be considered as candidates for further orofacial myofunctional assessment."
Obstructive sleep apnea and anatomical structures of the nasomaxillary complex in adolescents
Jeong-Hyun Kang 1, Hyun Jun Kim 2, Seung Il Song 3
https://pubmed.ncbi.nlm.nih.gov/35925992/
"The results from multivariate linear regression demonstrated that the BMI, width of the nasal base, and SNA showed significant contributions to the severity of OSA in adolescents. The features of the nasomaxillary complex seemed to have significant influences on development and severity of OSA."
Benefit of early Class II treatment — a treatise on validity of the 1998 Carolina randomized clinical trial
John Hayes
"We conclude that, for children with moderate to severe CL II problems, early treatment [a phase 1 of care] followed by later comprehensive treatment [a second phase of care] on average does not produce major differences in jaw relationship or dental occlusion [than waiting to start later—with 1 phase of care].2"