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The aim of the work This pilot study was designed to monitor the prevalence of obstructive sleep apnea (OSA) in a pediatric population of patients aged 6 to 12 years, referred for orthodontics. At the same time, we focused on the analysis of sleep-disordered breathing depending on the presence of orthodontic anomalies and the preference of mouth breathing. Our hypothesis was that their presence represents a risk factor for the development of OSA. File A total of 100 children (43 boys and 57 girls; mean age ± standard deviation, 9.6 ± 1.7 years) of Czech or Slovak nationality participated in the study. Patients were approached for the study before the start of their therapy at the referred to the Orthodontic Department of the St. Anne’s University Hospital in Brno, Czech Republic.c Methodology A detailed medical history was taken from all patients, and the patient's legal representative filled out the "Pediatric Sleep Questionnaire" originally designed by us, which is partly based on sleep questionnaires used abroad. The patients underwent initial orthodontic examination, including complex check-up, intra- and extraoral photographs, cephalogram and panoramic x-ray. All patients underwent a home sleep testing with the use of Alice OneNight device, Philips Respironics (Murrysville, USA) to determine the presence and severity of OSA according to the measured apnea-hypopnea index (AHI). The children were sent for an ENT examination, where they underwent an endoscopic examination of the nose and nasopharynx with photo documentation and tonsils grading, The results In 61% of children, an AHI of 1 to 4 was measured, which corresponds to the finding of a mild form of OSA in the child. 7% of the children had an AHI between 5 and 10, which indicates a moderate form, and none of the examined children had an AHI > 10, i.e. a severe degree of OSA. The size of the palatine tonsils (correlation coefficient r = 0.35; p < 0.05) and the preference of mouth breathing during the day and at night (r = 0.41; p < 0.001) were positively correlated with the severity of OSA in children. A statistically highly significant positive correlation was found between AHI and maxillary constriction (r = 0.35; p < 0.001), and at the same time we noted a negative correlation between the parameter determining the range of tongue mobility, which is determined by the shortening of the sublingual frenulum (TRMR), and constriction of the upper jaws (r = -0.39; p < 0.001). This parameter was also negatively correlated with AHI (r = -0.16; p < 0.01). Among other orthodontic anomalies, a correlation was found between higher AHI values and crowding (r = 0.19; p < 0.05), as well as increased overjet (r = 0.31; p < 0.01). When analyzing the cephalometric images, we noted a positive correlation between the ANB angle and the AHI value (r = 0.16; p < 0.01). In our group of patients, we did not find a relationship between the severity of OSA and BMI, the size of the adenoid vegetation, the lower position of the hyoid bone, or the individual's tendency to vertical growth pattern (p > 0.05). Conclusion Based on the results of home sleep testing, we found the presence of OSA in 68% of children delegated for orthodontic examination, of which 10% of the cases involved a moderate form of OSA. Our hypotheses about the relationship between mouth breathing preference and some types of orthodontic anomalies to pediatic OSA were confirmed.
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