Video polysomnography and dentofacial features in a case of sleep-disordered breathing and bruxism

Aims Obstructive sleep apnea (OSA) is the most common condition among a group of disorders, called sleep-disordered breathing, that can affect both adults and children. It is characterized by repeated episodes of airway obstruction for more than 10 seconds during sleep, resulting in pauses in breathing. OSA is associated with significant metabolic, cardiovascular, and neurocognitive sequelae in children. Children with OSA have increased upper airway resistance during sleep due to a combination of soft tissue hypertrophy, craniofacial dysmorphology, and/or obesity. Sleep bruxism (SB) is a sleep-movement disorder. It is characterized by rhythmic masticatory muscle activity (RMMA), which consists of recurrent episodes of phasic or tonic jaw muscle contractions during sleep with or without tooth grinding. The gold standard for diagnosis of OSA and SB is overnight polysomnographic testing. Case report MB is a 10-year-old boy with loud snoring, pauses in breathing while asleep, agitated sleep with frequent awakenings, bizarre sleeping positions, bruxism, and poor academic performance in whom pharmacotherapy is being considered. Past medical history includes adenotonsillectomy and seasonal respiratory infections. BMI 18,1 (healthy weight). A parent school-aged children questionnaire is filled in. The orthodontic examination shows a narrow skeletal upper jaw, mandibular retrognathism and tooth wear. The patient underwent comprehensive polysomnography with video/audio recording. Results Sleep macrostructure was characterized by sleep fragmentation with high number of awakenings/arousals and prolonged REM latency. Some arousals were associated with RMMA, withoud tooth grinding but with oro-buccal activity semiologically similar to bruxism. Microstructure of sleep was instable, with increase in CAP rate. The apnea hypopnea index (AHI) was 5,7/h per hour (normal < 1.0 per hour in children), min SaO2 96,7%. The patient was treated with rapid maxillary expansion followed by a jaw advancement device. Conclusions When there is residual OSA after T & A is performed, other factors should be evaluated to decide the next course of action. For children with a high arched palate, rapid maxillary expansion has been shown to improve AHI. To manage sleep disorders optimally in school-aged children and to improve quality of sleep and academic performance, it is to be hoped that dentists and sleep specialist cooperate.