Journal articles: 'Sleep apnea syndromes'

1

VanDercar, D. H., A. P. Martinez, and E. A. De Lisser. "Sleep Apnea Syndromes." Anesthesiology 74, no. 3 (March 1, 1991): 623–24. http://dx.doi.org/10.1097/00000542-199103000-00036.

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UMEDA, Hiromichi. "Sleep apnea syndromes." Nihon Naika Gakkai Zasshi 74, no. 9 (1985): 1214–17. http://dx.doi.org/10.2169/naika.74.1214.

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Collop, Nancy A. "Obstructive Sleep Apnea Syndromes." Seminars in Respiratory and Critical Care Medicine 26, no. 01 (February 2005): 13–24. http://dx.doi.org/10.1055/s-2005-864198.

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Guilleminault, Christian, and Vivien C. Abad. "Obstructive sleep apnea syndromes." Medical Clinics of North America 88, no. 3 (May 2004): 611–30. http://dx.doi.org/10.1016/j.mcna.2004.01.002.

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Ishida, Tatsuya. "Hemodynamics in Sleep Apnea Syndromes." Practica oto-rhino-laryngologica. Suppl. 1993, Supplement61 (1993): 112–25. http://dx.doi.org/10.5631/jibirinsuppl1986.1993.supplement61_112.

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Ramar, Kannan, R. Nisha Aurora, Susmita Chowdhuri, Sabin R. Bista, Kenneth R. Casey, Carin I. Lamm, David A. Kristo, et al. "Treatment of Central Sleep Apnea Syndromes." Sleep 35, no. 9 (September 2012): 1199. http://dx.doi.org/10.5665/sleep.2068.

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Issack BIYONG, Florin Antoine Orha, Emilia Anna Sforza, and Guido Bondolfi. "Sleep apnea syndrome and psychiatric syndromes and complications or comorbidities?" World Journal of Advanced Research and Reviews 19, no. 3 (September 30, 2023): 076–85. http://dx.doi.org/10.30574/wjarr.2023.19.3.0786.

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Introduction: This study investigated the relationship between sleep disorders and psychiatric disorders. Several studies have shown that there is a correlation between these two types of disorders, but it is important to better understand this relationship to help diagnose and treat patients with these disorders. Method: We reviewed several studies conducted by leading universities on the relationship between sleep disorders and psychiatric disorders. We also examined the effects of certain medications on these disorders. Results: The studies showed that there is a correlation between sleep apnea and anxiety and depressive disorders. In addition, sleep deprivation has been associated with an increased risk of developing mood disorders such as depression and anxiety, as well as psychotic disorders such as schizophrenia. However, some medications, such as Quetiapine, have been effective in treating patients with psychotic disorders. Discussion: The results of this study highlight the importance of considering sleep disorders in the diagnosis and treatment of psychiatric disorders. It is essential to monitor metabolic parameters when using antipsychotic medications such as quetiapine. Management of sleep disorders may also be an effective way to prevent or treat associated psychiatric disorders. Conclusion: In sum, this study highlights the importance of considering sleep disorders in the diagnosis and treatment of psychiatric disorders, and underscores the effectiveness of treatments such as Quetiapine, Fluvoxamine and CPAP in managing these disorders. Considering the quality of sleep can thus contribute to significantly improve the quality of life of patients.

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Thomas, Robert Joseph. "Multimodality Therapy for Sleep Apnea Syndromes." Journal of Clinical Sleep Medicine 08, no. 05 (October 15, 2012): 565–67. http://dx.doi.org/10.5664/jcsm.2158.

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Sharma, Anuja. "Central Sleep Apnea Syndromes - A Review." Indian Journal of Sleep Medicine 6, no. 4 (2011): 130–34. http://dx.doi.org/10.5005/ijsm-6-4-130.

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Defabjanis, Patrizia. "Impact of nasal airway obstruction on dentofacial development and sleep disturbances in children: preliminary notes." Journal of Clinical Pediatric Dentistry 27, no. 2 (January 1, 2004): 95–100. http://dx.doi.org/10.17796/jcpd.27.2.27934221l1846711.

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Respiratory disorders in the upper respiratory tract during sleep are most often part of a continuous pathological process of long standing. Schematically, three clinical syndromes with increasing severity are described: breathing with the mouth open, snoring and sleep apneal hypopnea syndrome. Obstructive sleep apnea syndrome (OSAS) is a subtle, but severe sleep disorder of early childhood. It is often difficult to detect and may have long-term consequences, including failure to thrive, behavioral disturbances, developmental delay, and cor pulmonale.1 These conditions always include a functional maxillofacial perturbation, which may be associated with a constitutional or acquired morphological disorder. Pediatric dentists must be aware of the problems connected with mouth breathing and OSAS (obstructive sleep apnea syndrome) in children as any delay in diagnosis and treatment may cause prolonged morbidity. They also have a role in the diagnosis and co-management of these patients because the signs and symptoms may be recognizable in the dental practice. Besides the medical approach itself, the treatment sometimes is surgical, always orthopedic: the earlier it is initiated, the more effective, simple and unrestraining it is. The aim of this work is to focus attention on the early diagnosis and prevention of these pathologies. Diagnostic guidelines will be illustrated.

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Kryger, Michael A., and Veronica J. Chehata. "Relationship Between Sleep-Disordered Breathing and Neurogenic Obesity in Adults With Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 27, no. 1 (January 1, 2021): 84–91. http://dx.doi.org/10.46292/sci20-00044.

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Spinal cord injury (SCI) substantially increases the risk of neurogenic obesity, diabetes, and metabolic syndrome. Much like in the general population, a discussion of these syndromes in SCI would be incomplete without acknowledging the association of SCI with sleep-disordered breathing (SDB). This article will outline the interplay between obesity and obstructive sleep apnea (OSA), discussing the pathophysiology of obesity in OSA both for the general population and SCI population. The role of insulin resistance in SDB and SCI will also be examined. The epidemiology and pathophysiology of OSA and central sleep apnea in SCI are discussed through an examination of current evidence, followed by a review of central sleep apnea in SCI. Principles of diagnosis and management of SDB will also be discussed. Because sleep deprivation in itself can be a risk factor for developing obesity, the significance of comorbid insomnia in SCI is explored. Ultimately, a thorough sleep history, testing, and treatment are key to improving the sleep of individuals with SCI and to potentially reducing the impact of neurogenic obesity and metabolic syndrome.

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Goldstein, Steven J., Richard H. K. Wu, Michael J. Thorpy, Robert J. Shprintzen, Robert E. Marion, and Paul Saenger. "Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea." Acta Endocrinologica 116, no. 1 (September 1987): 95–101. http://dx.doi.org/10.1530/acta.0.1160095.

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Abstract. Obstructive sleep apnea may lead to disordered sleep architecture and impair the physiologic slow wave sleep related growth hormone release. Obstructive sleep apnea occurs with craniofacial syndromes and in children with airway narrowing, pharyngeal hypoplasia, tonsillar adenoidal hypertrophy, micrognathia and achondroplasia. To examine the relationship between disordered sleep and growth hormone release we studied a 9 year old male with achondroplasia, growth failure (3 cm/year) and obstructive sleep apnea. Polysomnography data and a 20 min sampling for sleep entrained growth hormone showed before therapeutic tracheostomy numerous apneic episodes, absent slow wave sleep and abnormal low growth hormone secretion during sleep. Normalized slow wave sleep entrained growth hormone secretion after tracheostomy led to a sustained increase in growth rate. Normal growth rate (> 5 cm/year) continues 2 years after tracheostomy. We conclude that obstructive sleep apnea may impair sleep related growth hormone release. Obstructive sleep apnea may be a useful model for other diseases in which growth failure and sleep disturbances are linked.

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Arias, Miguel A., Francisco García-Río, Alberto Alonso-Fernández, and Ana M. Sánchez. "Sleep Apnea-Hypopnea Syndromes and Heart Failure." Revista Española de Cardiología (English Edition) 60, no. 4 (January 2007): 415–27. http://dx.doi.org/10.1016/s1885-5857(07)60174-1.

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Sivaram, Ganeshraj, Kahir Jawad, Karim El-Kersh, Mark Chariker, Kelly Betz, and Egambaram Senthilvel. "0793 Sleep Disordered Breathing in Children with Craniofacial Syndromes." SLEEP 47, Supplement_1 (April 20, 2024): A340. http://dx.doi.org/10.1093/sleep/zsae067.0793.

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Abstract Introduction Children with Craniofacial Syndrome (CFS) are known to have a higher risk for Obstructive Sleep Apnea (OSA) due to various craniofacial abnormalities. We aim to assess OSA prevalence in a single cohort of children suffering from CFS and to stratify them by degree of OSA (mild, moderate, severe) and the overall management of OSA in CFS. Methods This was a single-center retrospective study that included children with confirmed CFS who underwent overnight polysomnography (PSG). OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as normal (< 1 event/hr), mild (1–4.9 events/h), moderate (5–9.9 events/h), and severe (≥ 10 events/h). Results PSG data were available for 46 children; 58.7% were male, with a mean age of 4.8 years. The average BMI was 18.2 (SD + 5.4 kg/m2) with an average z-score of 1.1 (SD + 4.0), and 76.1% of patients were Caucasian. Common referring symptoms were snoring (38.1%), witnessed apneas (29.1%), gasping/choking (17.4%), and oxygen desaturation (15.1%). The most common CFS was Pierre Robin Sequence (PRS) in 34.8%. OSA prevalence was 68.2% (23.3% mild, 20% moderate, 56.7% severe). The mean polysomnographic variables were total sleep time 346.2 min (± 120.0), AHI 22.2 (± 32.4), SaO2 nadir 83.8% (± 12.1), maximum CO2 level 54 mmHg (± 9.9), and arousal index 22.2 (± 23.4). The overall treatments consisted of mandibular distraction in 26.5%, continuous positive airway pressure therapy in 12.2%, tracheostomy in 6.1%, oxygen supplement in 2%, and lip-tongue adhesion in 2%. Conclusion In our cohort of children with CFS had a high prevalence of OSA with severe degree as the prevalent severity. PRS was the most common CFS and mandibular distraction was the most commonly performed procedure in infants with PRS. Support (if any)

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Carroll, John L., Carole L. Marcus, and Gerald M. Loughlin. "Disordered Control of Breathing in Infants and Children." Pediatrics In Review 14, no. 2 (February 1, 1993): 51–65. http://dx.doi.org/10.1542/pir.14.2.51.

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Introduction Breathing must be tightly regulated so that the amount of oxygen inhaled and carbon dioxide exhaled matches precisely the metabolic needs of the body. Acute malfunction of breathing control mechanisms, even for a few seconds, may lead rapidly to serious physiologic derangements, with death as the final outcome if the system fails to recover. Chronic malfunction of breathing control mechanisms may lead to chronically abnormal blood gases (eg, hypoxemia), with such consequent complications as developmental delay or cor pulmonale. Because the upper airway is shared for breathing, eating, drinking, and talking, control of breathing also encompasses coordination of these actions in such a way that all are carried out effectively. The upper airway also must be actively held open during sleep or it will collapse during the inspiratory phase of breathing. Tone and activity of the muscles that maintain upper airway patency are controlled, in part, by the respiratory control systems. Malfunction of upper airway control mechanisms may play a role in obstructive sleep apnea. Thus, respiratory control not only refers to the control of gas exchange, but encompasses breathing pattern, apnea, respiratory protective reflexes, and upper airway control—specifically, maintenance of upper airway patency. This review will cover infant apnea and home cardiorespiratory monitoring, apparent life-threatening events (ALTEs) and home monitoring, obstructive sleep apnea syndrome (OSAS) in children, central hypoventilation syndromes, and hyperventilation syndromes.

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Thanaviratananich, Sikawat, Hao Cheng, Maria Pino, and Krishna Sundar. "393 Comparison of Oxygenation Abnormalities Between Obstructive Sleep Apnea and Central Sleep Apnea." Sleep 44, Supplement_2 (May 1, 2021): A156—A157. http://dx.doi.org/10.1093/sleep/zsab072.392.

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Abstract Introduction The apnea-hypopnea index (AHI) is used as a generic index to quantify both central sleep apnea (CSA) and obstructive sleep apnea (OSA) syndromes. Patterns of oxygenation abnormalities seen in CSA and OSA may be key to understanding differing clinical impacts of these disorders. Oxygen desaturation and resaturation slopes and durations in OSA and CSA were compared between OSA and CSA patients. Methods Polysomnographic data of patients aged 18 years or older with diagnosis of OSA and CSA, at University of Iowa Hospitals and Clinics, were analyzed and demographic data were collected. Oximetric changes during hypopneas and apneas were studied for desaturation/resaturation durations and desaturation/resaturation slopes. Desaturation and resaturation slopes were calculated as rate of change in oxygen saturation (ΔSpO2/Δtime). Comparison of hypoxemia-based parameters between patients with OSA and CSA was performed using unpaired t-test. Results 32 patients with OSA with median AHI of 15.4 (IQR 5.1 to 30.55) and median ODI of 15.47 (IQR 9.50 to 29.33) were compared to 15 patients with CSA with a median AHI of 20.4 (IQR 12.6 to 47.8) and median ODI of 27.56 (IQR 17.99 to 29.57). The mean number of desaturation and resaturation events was not significantly different between patients with OSA and CSA (OSA - 106.81±87.93; CSA - 130.67±76.88 with a p-value 0.1472). 4/15 CSA patients had Cheyne-Stokes breathing, 2/15 had treatment emergent central sleep apnea, 1/15 had methadone-associated CSA and for 8/15, no etiologies for CSA were found. Mean desaturation durations was significantly longer in OSA (20.84 s ± 5.67) compared to CSA (15.94 s ± 4.54) (p=0.0053) and consequently the desaturation slopes were steeper in CSA than OSA (-0.35%/sec ±0.180 vs. -0.243 ± 0.073; p=0.0064). The resaturation duration was not significantly longer in OSA (9.76 s ± 2.02) than CSA (9.057 s ± 2.17) (p=0.2857). Differences between desaturation duration and slopes between CSA and OSA persisted during REM and NREM sleep, and in supine sleep. Conclusion As compared to OSA, patients with CSA have different patterns of desaturations and resaturations with lesser hypoxic burden with CSA. This may have implications on the clinical outcomes seen between these two disorders. Support (if any):

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Ananth, Ashwin, Elie Fares, Emily Sagalow, Swetha Nemargamulla, and Zhanna Fast. "860 Variable Sleep Apnea Syndromes Complicated by Neurosurgeries in a Patient with Chiari Malformation Type 1." Sleep 44, Supplement_2 (May 1, 2021): A334—A335. http://dx.doi.org/10.1093/sleep/zsab072.857.

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Abstract Introduction Chiari malformations (CM) are congenital conditions defined by craniocervical junction anatomic anomalies with downward displacement of cerebellar structures. Sleep-disordered breathing (SDB) including obstructive sleep apnea (OSA), bradypnea, central sleep apnea (CSA), and hypoventilation are described in CM patients. Report of case(s) 31-year-old male with history of CM type 1 presented to the sleep medicine clinic for management of OSA and CSA diagnosed at age 16. PSG showed an apnea-hypopnea index (AHI) of 14.2, RDI of 29, and no central events. He was started on auto-CPAP with pressures of 5–20 with subsequent visits showing high residual AHI. A subsequent CPAP-titration study resulted in a pressure of 16cm H2O yielding AHI of 0. CPAP pressure was fixed, but a high residual AHI persisted despite excellent compliance. A split-night study resulted in a BiPAP prescription, for which a titration study noted PAP-emergent CSA. He was started on auto Bilevel with IPAP of 30, EPAP of 8 and backup rate of 12bpm. Despite treatment, elevated AHI persisted so he was switched to adaptive servo-ventilation (ASV) with nightly oxygen blended in resulting in controlled complex sleep apnea. SDB management was complicated by multiple neurosurgical decompressions. During the most recent procedure, he was found to have syringomyelia, syringobulbia, and a mass at the brainstem. Surgery, including placement of a 4th ventricle stent and mass excision, initially led to a decrease of residual AHI to a low of 0.7, before progressively increasing to 15. A repeat PSG demonstrated severe OSA (AHI of 35), without evidence of CSA or nocturnal hypoventilation. ASV was resumed and patient’s AHI progressively decreased to an average of 8, with improvement in his sleep apnea symptoms. Conclusion SDM in CM patients can be explained by condition-related anatomical changes and depression of respiratory centers due to possible extrinsic compression leading to complex sleep apnea presentations. While it is unclear why this patient’s sleep apnea improved then worsened after his latest decompression surgery, we believe that CSF recirculation and postoperative inflammation may be responsible. Close monitoring of SDB in patients with CM is important as they may require advanced therapies for proper control. Support (if any):

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Kunter, Erdogan, Ozkan Yetkin, and Hakan Gunen. "UARS presenting with the symptoms of anxiety and depression." Open Medicine 5, no. 6 (December 1, 2010): 712–15. http://dx.doi.org/10.2478/s11536-009-0127-1.

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AbstractUpper airway resistance syndrome (UARS) is a condition where the apnea-hypopnea index is less than 5 and respiratory-effort related arousal index is more than 10. The clinical presentation of UARS may be the same as obstructive sleep apnea-hypopnea syndrome (OSAS); it sometimes shows up with symptoms hardly suggestive of a sleep-disordered breathing. A 17 year-old male patient had applied to a local psychiatry clinic and complained of chronic fatigue, insomnia, behavioral and academic problems and was treated for anxiety and depression. After a period of unresponsive treatment, he was sent to a sleep center for evaluation of insomnia, which turned out to be a fragmented, unrefreshing sleep episode. Polysomnographical evaluation revealed that he had UARS without OSAS. His complaints decreased dramatically after he received CPAP treatment. This case shows that UARS should be considered in young patients with functional somatic syndromes even if the clinical presentation does not apparently imply the condition.

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Mixter, Roger C., David J. David, William H. Perloff, Christopher G. Green, Richard M. Pauli, and Peter M. Popic. "Obstructive Sleep Apnea in Apertʼs and Pfeifferʼs Syndromes." Plastic and Reconstructive Surgery 86, no. 3 (September 1990): 457–63. http://dx.doi.org/10.1097/00006534-199009000-00011.

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Papsidero, Michael J., and Howard L. Levine. "Sleep Apnea Syndromes and Snoring: An Algorithmic Approach." Otolaryngology–Head and Neck Surgery 112, no. 5 (May 1995): P83. http://dx.doi.org/10.1016/s0194-5998(05)80190-1.

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Selim, Bernardo J., and Kannan Ramar. "Management of Sleep Apnea Syndromes in Heart Failure." Sleep Medicine Clinics 12, no. 1 (March 2017): 107–21. http://dx.doi.org/10.1016/j.jsmc.2016.10.004.

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Selim, Bernardo J., Mithri R. Junna, and Timothy I. Morgenthaler. "Therapy for Sleep Hypoventilation and Central Apnea Syndromes." Current Treatment Options in Neurology 14, no. 5 (August 25, 2012): 427–37. http://dx.doi.org/10.1007/s11940-012-0188-3.

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Thomas, Robert Joseph. "Single vs. Multi-Modality Treatment of Central Apnea Syndromes." Sleep 35, no. 9 (September 2012): 1197–98. http://dx.doi.org/10.5665/sleep.2066.

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Nishimura, Tadao, Kiyokazu Hasegawa, Natsuki Morishima, and Mikio Yagisawa. "Sleep Apnea Syndrome, Up to Date. Dynamic MRI and Midline Laser Glossectomy for Snoring and Obstructive Sleep Apnea Syndromes." Nihon Kikan Shokudoka Gakkai Kaiho 47, no. 2 (1996): 101–6. http://dx.doi.org/10.2468/jbes.47.101.

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Gaig, Carles, Francesc Graus, Yarko Compta, Birgit Högl, Luis Bataller, Norbert Brüggemann, Caroline Giordana, et al. "Clinical manifestations of the anti-IgLON5 disease." Neurology 88, no. 18 (April 5, 2017): 1736–43. http://dx.doi.org/10.1212/wnl.0000000000003887.

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Objective:To report the presentation, main syndromes, human leukocyte antigen (HLA) association, and immunoglobulin G (IgG) subclass in the anti-IgLON5 disease: a disorder with parasomnias, sleep apnea, and IgLON5 antibodies.Methods:This was a retrospective clinical analysis of 22 patients. The IgG subclass was determined using reported techniques.Results:Patients' median age was 64 years (range 46–83). Symptoms that led to initial consultation included sleep problems (8 patients; 36%), gait abnormalities (8; 36%), bulbar dysfunction (3; 14%), chorea (2; 9%), and cognitive decline (1; 5%). By the time of diagnosis of the disorder, 4 syndromes were identified: (1) a sleep disorder with parasomnia and sleep breathing difficulty in 8 (36%) patients; (2) a bulbar syndrome including dysphagia, sialorrhea, stridor, or acute respiratory insufficiency in 6 (27%); (3) a syndrome resembling progressive supranuclear palsy (PSP-like) in 5 (23%); and (4) cognitive decline with or without chorea in 3 (14%). All patients eventually developed parasomnia, sleep apnea, insomnia, or excessive daytime sleepiness. HLA-DRB1*10:01 and HLA-DQB1*05:01 were positive in 13/15 (87%) patients; the DRB1*10:01 allele was 36 times more prevalent than in the general population. Among 16 patients with paired serum and CSF samples, 14 had IgLON5 antibodies in both, and 2 only in serum (both had a PSP-like syndrome). Twenty of 21 patients had IgG1 and IgG4 antibodies; the latter predominated in 16.Conclusions:Patients with IgLON5 antibodies develop a characteristic sleep disorder preceded or accompanied by bulbar symptoms, gait abnormalities, oculomotor problems, and, less frequently, cognitive decline. IgG4 subclass antibodies predominate over IgG1; we confirm a strong association with the HLA-DRB1*10:01 allele.

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Schumacher, Mark A. "Pain Management for the Obese Sleep Apnea Patient." ICU Director 3, no. 2 (March 2012): 80–84. http://dx.doi.org/10.1177/1944451612438918.

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Currently, one third of the US adult population is considered obese. As such, obese patients are a rapidly growing population of patients being admitted to ICU. The problems in managing pain for these patients, primarily perioperative and hospital-associated respiratory depression, are becoming increasingly apparent. New approaches for pain management are intended to minimize the life-threatening side effects of traditional pain control drugs (opioids) and to increase the therapeutic options with nonopioid agents. This article ( a) reviews the pathophysiology of obstructive sleep apnea and other related sleep apnea syndromes, ( b) describes risk factors for perioperative and hospital-associated respiratory depression, ( c) reviews other significant side effects of opioid analgesic agents, and finally ( d) summarizes the emerging consensus for the use of multimodal analgesia for managing pain in obese patients with obstructive sleep apnea.

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Mojon, Daniel. "Eye diseases associated with sleep apnea syndrome." Therapeutische Umschau 58, no. 1 (January 1, 2001): 57–60. http://dx.doi.org/10.1024/0040-5930.58.1.57.

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Beim Schlafapnoe Syndrom treten während dem Schlaf rezidivierend komplette oder partielle Obstruktionen der oberen Luftwege auf. Die Erkrankung gilt als Risikofaktor für verschiedene kardiovaskuläre und zerebrovaskuläre Erkrankungen. Diverse Augenkrankheiten wurden mit dem Schlafapnoe Syndrom assoziiert. An der Bindehaut zeigt sich gehäuft eine chronische Konjunktivitis im Rahmen eines «Floppy Eyelid»-Syndromes oder einer undichten Maske, die zur therapeutischen Überdruckbeatmung verwendet wird. Die Augenlider können eine Oberlidptose, ein Unterlidektropium, eine Blepharochalase oder eine Trichiasis aufweisen. An der Hornhaut finden sich gehäuft infektiöse Keratitiden, trockene Augen, rezidivierende Erosionen, ein Keratokonus und progressive Endothelschädigungen. Diverse Optikusneuropathien scheinen ebenfalls gehäuft beim Schlafapnoe Syndrom aufzutreten.

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Narang, Indra, and Joseph L. Mathew. "Childhood Obesity and Obstructive Sleep Apnea." Journal of Nutrition and Metabolism 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/134202.

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The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA), occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG), is characterised by snoring, recurrent partial (hypopneas) or complete (apneas) obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA.

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Warunek, Stephen P. "Oral appliance therapy in sleep apnea syndromes: a review." Seminars in Orthodontics 10, no. 1 (March 2004): 73–89. http://dx.doi.org/10.1053/j.sodo.2003.10.006.

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Ward, Denham S. "Control of breathing, ventilatory failure and sleep apnea syndromes." Current Opinion in Anaesthesiology 5, no. 6 (December 1992): 843–47. http://dx.doi.org/10.1097/00001503-199212000-00016.

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Yasuda, Yoshifumi, Akihito Umezu, Satoshi Horihata, Katsunori Yamamoto, Ryuji Miki, and Shigefumi Koike. "Modified thoracic impedance plethysmography to monitor sleep apnea syndromes." Sleep Medicine 6, no. 3 (May 2005): 215–24. http://dx.doi.org/10.1016/j.sleep.2004.09.002.

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Philip-Joet, François F., Marc F. Rey, Andre A. DiCroco, Martine J. Reynaud-Gaubert, and Alain G. Arnaud. "Semi-automatic Analysis of Electroencephalogram in Sleep Apnea Syndromes." Chest 104, no. 2 (August 1993): 336–39. http://dx.doi.org/10.1378/chest.104.2.336.

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Boiko, N. V., G. M. Letifov, and N. G. Letifova. "Psychosomatic disorders in children with obstructive sleep apnea." Terapevt (General Physician), no. 3 (March 6, 2023): 42–50. http://dx.doi.org/10.33920/med-12-2303-06.

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Sleep-related breathing disorders in children are usually caused by adenotonsillar hypertrophy and associated with many related disorders: pulmonary hypertension, developmental delay, sleepwalking, attention deficit hyperactivity disorder, obstructive sleep apnea, and enuresis. Numerous studies indicate the correlation of the above syndromes. Surgical removal of airway obstruction (adenotonsil lectomy) in most cases leads to complete resolution or significant improvement of comorbid disorders. A comprehensive interdisciplinary approach to the examination of this category of patients and their treatment with the participation of pediatricians, psycho-neurologists, and ENT specialists is required.

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Czuma, Richard, Robert Thomas, Jason Maley, and Danielle Gott. "0969 Severe persistent specific sleep disorders in post-acute sequelae of SARS-CoV-2." SLEEP 46, Supplement_1 (May 1, 2023): A427. http://dx.doi.org/10.1093/sleep/zsad077.0969.

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Abstract Introduction Viral infections have long been associated with sleep disorders, especially hypersomnia following the acute phase The Covid-19 epidemic has resulted in a post-viral syndrome called post-acute sequelae of SARS-CoV-2 (PASC), or Long-Covid. Sleep has been reported to be severely disturbed during acute Covid-19 infection, and is a major feature of PASC. Much of the subjective data is based on questionnaires, with a paucity of objective sleep evaluations including polysomnography. We share our early experience with diagnosis and management of sleep disorders in PASC. Methods PASC patients are seen in a dedicated Long-Covid clinic at the Beth Israel Deaconess Medical Center for a comprehensive evaluation. The patients presented with new onset persistent sleep impairments shortly following acute COVID-19 infection, without pre-existing sleep impairments, in association with a clinical diagnosis of long covid. Sleep symptoms (excessive sleepiness, hypersomnia/long sleep, and insomnia) are identified and those who consider these a key symptom are referred to the Covid Sleep Clinic, for formal sleep evaluation by RJT. Diagnostic evaluations include polysomnography (extended for hypersomnia diagnosis), Multiple Sleep Latency Test for excessive daytime sleepiness, and home sleep apnea test for suspected sleep apnea. Sleep logs and sleep quality using a Ring oximeter-based SleepImage system complements evaluation of sleep-wake instability. Standard management is offered based on the ensuing diagnosis. Results Twenty-six patients (age range 22 to 58 years, 16 females) have been evaluated in this sleep pathology enriched pathway. Specific new sleep disorders diagnosis so far have included narcolepsy without cataplexy (3), hypersomnia with long sleep (3), hypersomnia without long sleep (3), rapid eye movement sleep disorder (2), persistent insomnia (3), a sleep-wake instability syndrome we call cyclical insomnia (2), and sleep apnea (7). Treatment has included CPAP, stimulants, modafinil, and sodium oxybate. Clinical responses to treatment have so far been as expected. One patient with cyclical insomnia has had a marked subjective and objective improvement with low dose (250 mg) sodium valproate. Conclusion PASC/Long-Covid can induce specific sleep syndromes. These include narcolepsy, hypersomnia, persistent insomnia, sleep-wake instability, and REM-behavior disorder. Support (if any)

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Tu, Xinhang, Victor Peng, Anayansi Lasso-Pirot, and Montserrat Diaz-Abad. "0837 Average Volume-Assured Pressure Support (AVAPS) after CPAP Failure in A Pediatric Patient with Severe Obstructive Sleep Apnea and Sleep-Related Hypoventilation." Sleep 45, Supplement_1 (May 25, 2022): A361. http://dx.doi.org/10.1093/sleep/zsac079.831.

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Abstract Introduction Obstructive sleep apnea (OSA) has become an increasingly pervasive sleep disorder in the pediatric population. Current mainstream treatments include adenotonsillectomy and positive airway pressure therapy. Average volume-assured pressure support (AVAPS) is a relatively new mode of non-invasive ventilation, which has been increasingly used in the treatment of respiratory failure and hypoventilation syndromes. Here we present a case of a pediatric patient with severe OSA and sleep-related hypoventilation who was successfully treated with AVAPS after failure of CPAP therapy. Report of Cases: A four year old boy with history of severe OSA, severe obesity, asthma, and allergic rhinitis underwent polysomnography one year after adenotonsillectomy and nasal turbinate reduction due to continued symptoms of sleep-disordered breathing. Results showed elevated residual apnea-hypopnea index (AHI = 30.4 events/hour), sleep-related hypoventilation (T ETCO2≥50 = 228.3 minutes), and sleep-related hypoxemia (T≤90% = 7 minutes). Therefore the patient underwent repeated adenotonsillectomy and turbinate reduction, with post-operative course complicated by pulmonary edema requiring intubation. He was extubated and weaned to nocturnal CPAP. Following discharge, CPAP titration failed to control AHI at maximal pressure (AHI 54.5 on 20 cm H2O, T≤90% = 15.3 minutes). The patient was then started on AVAPS with auto-titrating EPAP (AVAPS-AE, settings Pmax 20 cm H2O, PS 2-10 cm H2O, EPAP 5-10 cm H2O, RR auto, room air) with subsequent improvement of snoring and witnessed apneas, as well as reduction of daytime sleepiness. Afterwards, AVAPS-AE titration confirmed resolution of obstructive sleep apnea, sleep-related hypoxemia, and sleep-related hypoventilation (AHI = 2.5, T≤90% = 1.2 minutes, T ETCO2 ≥50 = 6.5 minutes.) The patient has since remained stable on AVAPS-AE until age ten, with the most recent AVAPS titration demonstrating continued resolution of sleep-disordered breathing. Conclusion AVAPS was an effective treatment for a pediatric patient with severe OSA and sleep-related hypoventilation who had failed CPAP therapy. Support (If Any) None.

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Giles, Cristina, Benjamin Wisniewski, and Stephen Hawkins. "1191 A Pediatric Case of Treatment Emergent Central Sleep Apnea During High Flow Nasal Cannula Polysomnography." SLEEP 47, Supplement_1 (April 20, 2024): A509. http://dx.doi.org/10.1093/sleep/zsae067.01191.

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Abstract Introduction High flow nasal cannula (HFNC) is an alternative therapy to continuous positive airway pressure (CPAP) in pediatric populations with behavioral intolerance or contraindications to CPAP. Studies evaluating HFNC as a treatment modality in the pediatric literature have been limited. Report of case(s) A previously healthy 12-year-old male with a history of obesity presented with partial and full thickness burns to his face, neck, chest, and bilateral upper-extremities following a bonfire accident. His burns covered 15% of his total body surface area. He required hospitalization for acute burn management and skin grafting. During his hospitalization, he was observed to have snoring, witnessed apneas, and nocturnal hypoxemia concerning for underlying obstructive sleep apnea. He was unable to utilize a non-invasive positive pressure mask interface due to his extensive facial dressings and pressure sensitive skin grafts. He was discharged home on high flow nasal cannula at 10-15 Liters/minute. The patient experienced weight gain following hospitalization, possibly related to Cyproheptadine use for burn-related itching. Approximately 10 months after discharge, the patient underwent split-night HFNC polysomnography. The diagnostic portion of his study revealed severe obstructive sleep apnea with an OAHI of 28.8 events/hour. There were no observed central or mixed respiratory events and no REM stage sleep during the diagnostic portion of the study. After initiating HFNC at 40 L/minute and 34 degrees Celsius per sleep laboratory protocol, the OAHI decreased to 0.0 events/hour despite REM rebound, and the CAHI increased to 16.8 events/hour. This study was conducted at approximately the same altitude as the patient’s home. Conclusion This patient experienced treatment emergent central sleep apnea during HFNC polysomnography. Treatment emergent central sleep apnea with HFNC has previously only been described in a limited number of pediatric patients with underlying chronic lung disease, developmental delay, or genetic syndromes. This case highlights HFNC as an alternative treatment modality to CPAP as well as the need for further understanding of HFNC titration in pediatric sleep laboratories. Support (if any) The Breathing Institute at Children’s Hospital Colorado

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Alsaeed, Suliman, Nelly Huynh, David Wensley, Kevin Lee, Mona M. Hamoda, Evan Ayers, Kate Sutherland, and Fernanda R. Almeida. "Orthodontic and Facial Characteristics of Craniofacial Syndromic Children with Obstructive Sleep Apnea." Diagnostics 13, no. 13 (June 29, 2023): 2213. http://dx.doi.org/10.3390/diagnostics13132213.

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Introduction: Obstructive sleep apnea (OSA) is a disorder in which ventilation becomes disrupted due to a complete or partial upper airway obstruction Altered craniofacial morphology is one of the most important anatomical factors associated with obstructive sleep apnea (OSA). Studies have assessed craniofacial features in the non-syndromic pediatric population. The aim of this study was to analyze the orthodontic and facial characteristic of craniofacial syndromic children referred for polysomnography (PSG) and to assess the correlation with the apnea–hypopnea index (AHI). Methods: In the current cross-sectional study, consecutive syndromic patients referred for PSG were invited to participate. A systematic clinical examination including extra- and intra-oral orthodontic examination was performed by calibrated orthodontists. Standardized frontal and profile photographs with reference points were taken and analyzed using ImageJ® software to study the craniofacial morphology. PSG data were analyzed for correlation with craniofacial features. STROBE guidelines were strictly adopted during the research presentation. Results: The sample included 52 syndromic patients (50% females, mean age 9.38 ± 3.36 years) diagnosed with 17 different syndromes, of which 24 patients had craniofacial photography analysis carried out. Most of the sample (40%) had severe OSA, while only 5.8% had no OSA. Down’s syndrome (DS) was the most common syndrome (40%) followed by Goldenhar syndrome (5%), Pierre Robin Sequence (5%), and other syndromes. The severity of AHI was significantly correlated with decreased midfacial height. increased thyromental angle and cervicomental angle, decreased mandibular angle, and decreased upper facial height. All patients with DS were diagnosed with OSA (57% severe OSA), and their ODI was significantly correlated with increased intercanthal distance. Obesity was not correlated to the severity of AHI for syndromic patients. Conclusions: Decreased midfacial height and obtuse thyromental angle were correlated with increased AHI for syndromic patients. Increased intercanthal distance of DS patients could be a major predictor of OSA severity. Obesity does not seem to play a major role in the severity of OSA for syndromic patients. Further studies with larger samples are necessary to confirm these findings.

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Shapiro, Jo, Marshall Strome, and Allen C. Crocker. "Airway Obstruction and Sleep Apnea in Hurler and Hunter Syndromes." Annals of Otology, Rhinology & Laryngology 94, no. 5 (September 1985): 458–61. http://dx.doi.org/10.1177/000348948509400508.

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The Hurler and Hunter syndromes are two forms of mucopolysaccharidosis. Although the diseases are rare, those afflicted commonly require otolaryngologic consultation. Upper airway obstruction is often severe, progressive, and not infrequently the suspected cause of death in these patients. Four patients with these problems are presented. In all of the children, obstructive sleep apnea was a major management problem. This and other upper airway difficulties are detailed with clinical and pathological correlates.

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Bodez, Diane, Aziz Guellich, Mounira Kharoubi, Ala Covali-Noroc, Claire-Marie Tissot, Soulef Guendouz, Luc Hittinger, et al. "Prevalence, Severity, and Prognostic Value of Sleep Apnea Syndromes in Cardiac Amyloidosis." Sleep 39, no. 7 (July 1, 2016): 1333–41. http://dx.doi.org/10.5665/sleep.5958.

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Hassan, Iman. "Treatment of central sleep apnea syndromes in adults: Practice parameters." Egyptian Journal of Chest Diseases and Tuberculosis 61, no. 3 (July 2012): 1–2. http://dx.doi.org/10.1016/j.ejcdt.2012.10.003.

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Rabiei, Samira, and Maryam Nazari. "Impacts of Coronavirus Disease 2019 Pandemic on Sleep Pattern." Sleep Medicine Research 14, no. 1 (March 31, 2023): 1–5. http://dx.doi.org/10.17241/smr.2022.01557.

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The ongoing coronavirus disease 2019 (COVID-19) pandemic is the third global crisis after two epidemics of severe acute respiratory syndromes. It has affected general public besides health care systems and governments. Confinements and lock downs have changed waking up time and going to bed time, ultimately affecting circadian clocks that can disturb sleep quality which can lead to anxiety, stress, and depression. This puts the most susceptible group -young adults and females- at risk of psychological disorders and even inflammatory events. Several kinds of sleep disorders due to COVID-19 including insomnia, sleep apnea, sleepiness during daytime, post-traumatic-like sleep dysfunction, abnormal dreams, and restless legs syndrome have been reported. As sleep deprivation can alter circadian clock and weaken immunity which makes human more susceptible to pulmonary inflammatory process of COVID-19 and even enhance its manifestations, it should be considered as an urgent complication that needs to be treated. Furthermore, longstanding effects of sleep disturbances during COVID-19 pandemic need to be elucidated.

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Maclean, Joanna E., David Fitzsimons, Dominic Fitzgerald, and Karen Waters. "Comparison of Clinical Symptoms and Severity of Sleep Disordered Breathing in Children with and without Cleft Lip and/or Palate." Cleft Palate-Craniofacial Journal 54, no. 5 (September 2017): 523–29. http://dx.doi.org/10.1597/15-309.

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Objective To determine whether the clinical presentation or severity of sleep disordered breathing differs between children with or without a history of cleft lip and/or palate (CL/P) presenting for sleep assessment. Design Retrospective chart review. Setting Tertiary care pediatric hospital cleft clinic, sleep clinic. Patients Children > 6 months of age presenting to the cleft clinic with sleep concerns and children without CL/P presenting to the sleep clinic in the same 2-year period. Main Outcomes Measures Clinical symptoms and overnight polysomnography (PSG) results. Results A total of 168 children (55 from cleft clinic, 113 from sleep clinic) were identified. Age at clinical review (6.6 ± 4.1 years versus 6.8 ± 4.0 years, P = ns), sex distribution (64.6% versus 58.4%, P = ns), and the presence of syndromes or significant medical conditions (12% versus 16%, P = ns) were similar between groups. Snoring was the reason for referral in 59% of children with CL/P and 69% of non-CL/P children ( P = ns). The only presenting feature that differentiated between the groups was a lower incidence of tonsillar enlargement in children with CL/P (33% versus 79%, chi-square 30.4, P < 0.001). Sleep study results showed similar apnea-hypopnea indices (6.2 ± 6.9 versus 7.9 ± 7.1 events/hr, P = ns) with more central apnea in children with CL/P (1.5 ± 1.5 versus 1.0 ± 1.0 events/hr, P = 0.017). Conclusions Snoring and obstructive sleep apnea are common in CL/P with less tonsillar enlargement than non-CL/P children. Children with CL/P have similar OSA severity compared to non-cleft children but more central apnea which may indicate differences in the control of breathing.

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Baser, Duygu Ayhan, Serdar Baser, and Adin Selcuk. "The Role of Weight Management as First-line Treatment Modality in Obstructive Sleep Apnea of Obese Patients." Eurasian Journal of Family Medicine 9, no. 2 (June 26, 2020): 103–8. http://dx.doi.org/10.33880/ejfm.2020090206.

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Aim: Weight loss has been shown to improve obstructive sleep apnea and is considered the first choice of treatment. The aim of this study is to evaluate the weight-management strategies and the relationship between the weight loss and obstructive sleep apnea on obese patients. Methods: A prospective study was applied on consecutive 50 patients with obstructive sleep apnea whose body mass indexes over 25. The first part of questionnaire form and the Epworth Sleepiness Scale scores was applied to patients by face to face interviews at first visit between November 2017 and May 2018. All of the patients who applied to the snoring policlinic were offered weight loss. The second part of questionnaire form and Epworth Sleepiness Scale scores was applied to patients after 3 months later and the weights 3 months after weight loss recommendation were also recorded. For the statistical analysis, SPSS 15.0 program was used. Results: All patients were offered to lose weight. 26% of them had only diet; 12% had only exercise and 12% had both diet and exercise. 50% of the patients did nothing to lose weight. 76.9% of the dieters; 100% of the exercisers and 83.3% of those who did diet and exercise, lost weight. There was a statistically significant difference between beginning and control (after 3 months) body mass indexes and Epworth Sleepiness Scale scores of the patients. Conclusion: When weight loss is considered as the patient's attempt, along with the pursuance and maintenance, its compliance is high. Although the number of sample in our study was not suitable for generalization, we confirmed that weight loss had a positive effect on obstructive sleep apnea. Keywords: sleep apnea syndromes, weight loss, obesity

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Kuo, William, Sang Le, Eugene Kim, and Carl (Yuan-Feng) Lo. "Congenital Myasthenic Syndrome With Malignant Hyperthermia Susceptibility in a Child Undergoing Adenotonsillectomy for Obstructive Sleep Apnea: A Case Report." A&A Practice 17, no. 10 (October 2023): e01723. http://dx.doi.org/10.1213/xaa.0000000000001723.

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Congenital myasthenic syndromes are rare genetic diseases involving pathologic proteins in the neuromuscular junction. Malignant hyperthermia susceptibility is a genetic disorder involving a hypermetabolic response to volatile anesthetics and depolarizing neuromuscular blocking agents. We present the first reported case of a 3-year-old boy with both congenital myasthenic syndrome and malignant hyperthermia susceptibility, resulting from a mutation in the ryanodine receptor type 1 gene, who underwent an adenotonsillectomy for severe obstructive sleep apnea. We discuss the anesthetic challenges in navigating these 3 comorbidities in the setting of airway surgery.

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Harrison, Jonathan, Ambrina Faiz, and Naomi Schlessinger. "Disturbed Sleep in Adult Patients with Sickle Cell Disease Assessed by the Pittsburgh Sleep Quality Index." Blood 110, no. 11 (November 16, 2007): 2265. http://dx.doi.org/10.1182/blood.v110.11.2265.2265.

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Abstract Although life expectancy for patients with sickling hemoglobinopathies has been improving in recent years, these patients continue to suffer significant morbidity throughout their lives, and pain is a prominent feature of these disorders. It has been shown that, in the primary care population, patients with the highest risk for sleep disturbances include those with pain (Alattar M, et al., J Am Board Fam Med, 2007, Vol 20, pp 365–74). It has also been reported that patients with sickle cell diseases have clinical features which resemble fibromyalgia syndrome (Schlessinger N, J Rheum, 2004, Vol 31, pp 598–600); fibromyalgia syndrome is characterized both pain and impaired sleep, among other features. In order to further investigate sleep disorders in sickle cell disease patients, patients in a sickle cell disease clinic were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Methods: Using a form IRB-approved specifically for this study, the PSQI was offered to patients in a sickle cell disease clinic, and completed anonymously. Results: 20 patients completed the PSQI with responses meaningful for analysis; they ranged in age from 21 to 50 years. On average, patients reported very poor overall quality of sleep; the mean Global PSQI score was 11.8 (S.D.4.8); this is as compared to historical, healthy control subjects who had a subjective mean Global PSQI score of 2.6. (Buysse D et al, Psychiatry Research, 1989, Vol 28, pp 193–213). All respondents reported that pain contributed to poor sleep at least once during the month prior to the survey, and half of the patients reported that pain contributed to poor sleep at least three times in the week prior to the survey. Fifty percent of those surveyed reported no sense of nocturnal dyspnea whatsoever; only 3 individuals reported that they felt that dyspnea contributed to poor sleep three or more times in the week prior to the survey, and frequent daytime somnolence was reported by only 10 percent of sickle cell patients responding to the survey. Habitual sleep efficiency appears poor in these patients, and subjective sleep quality is also reported as generally poor. Conclusions: Sleep disturbances appear to be very common in sickle cell disease patients, and some, but not all, aspects of these sleep disturbances resemble the characteristics of sleep impairment seen in patients with fibromyalgia syndrome (Osorio C, et al., J Rheum, 2006, Vol 33, pp 1863–65). Although sleep impairment in patients with sickle cell diseases has been attributed to sleep apnea syndromes in a subset of patients with sickle cell diseases, sleep disturbance associated with pain in sickle cell disease appears to be more widespread than could be explained by sleep apnea syndromes. Sleep disturbances associated with pain in sickle cell diseases may in turn lead to further exacerbation of symptoms arising from poor sleep. Interventions to improve sleep may reduce overall pain in these patients, as appears to be the case for patients with fibromyalgia syndrome (Rooks D, Curr Opin Rheum, 2007, Vol 2, pp 111–17).

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Cilli, Aykut, Fatih Uzer, AsliBostanci Toptas, Ummuhan Okur, Selen Bozkurt, Ebru Dogrul, and Murat Turhan. "Comparison of positional and rapid eye movement-dependent sleep apnea syndromes." Annals of Thoracic Medicine 13, no. 1 (2018): 42. http://dx.doi.org/10.4103/atm.atm_184_17.

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Büttner-Teleaga, A. "Neuropsychiatric consequences & traffic safety in patients with sleep apnea syndromes." Journal of the Neurological Sciences 357 (October 2015): e175. http://dx.doi.org/10.1016/j.jns.2015.08.605.

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Okada, T., T. Ohta, M. Terashima, Y. Kayukawa, M. Iwata, and A. Ito. "Three patterns of oxygen desaturation in patients with sleep apnea syndromes." Electroencephalography and Clinical Neurophysiology 61, no. 3 (September 1985): S193—S194. http://dx.doi.org/10.1016/0013-4694(85)90740-0.

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Marcus, Carole L. "Advances in management of sleep apnea syndromes in infants and children." Pediatric Pulmonology 27, S18 (1999): 188–89. http://dx.doi.org/10.1002/(sici)1099-0496(1999)27:18+<188::aid-ppul61>3.0.co;2-1.

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Narmada, Ida Bagus, Ervina R. Winoto, and Ailsa Marvalodya Hakim. "Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases." Indonesian Journal of Dental Medicine 5, no. 1 (June 23, 2022): 12–17. http://dx.doi.org/10.20473/ijdm.v5i1.2022.12-17.

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Background: Obstructive sleep apnea (OSA) is a breathing disorder that occurs during sleep and results in decreased or complete cessation of airflow despite attempts to breathe. Specific populations, such as children with certain craniofacial or other genetic syndromes and who are obese have a higher prevalence of OSA than the general population. Craniofacial abnormalities are one of the causes of OSA in the upper airway. Craniofacial morphologies that may predispose to OSA include retrognathia, anterior open bite, midface deficiency, and lower hyoid position. Therefore, interceptive orthodontic treatment in children is needed as one of the treatment options that can be chosen. Purpose: this study aimed to describe the interceptive orthodontic treatments and their effects on OSA cases in children. Review: Interceptive orthodontic treatment has various types depending on how the dentocraniofacial abnormality occurs. Orthodontic treatment aims to reduce the severity of OSA through maxillary and mandibular expansion, thereby increasing air space and airflow. Conclusion: Interceptive orthodontic treatment in pediatric OSA cases include; Rapid Maxillary Expansion, Twin-block, Propulsor Universal Light appliance, Planas appliance modified, Fränkel-II appliance, and BioAJustax oral appliance.

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Journal articles on the topic 'Sleep apnea syndromes'

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