Craniofacial determinants and the orthodontist's role in pediatric obstructive sleep apnea: Evidence review

<h2>Abstract</h2> The orthodontist's role in identifying and caring for children with obstructive sleep apnea (OSA) is gaining increasing attention, given the perceived close link between this multifactorial chronic disorder and craniofacial development. This evidence review examines the potential role of orthodontists in screening and adjunctive management of pediatric OSA, highlighting current evidence and its limitations. While some studies suggest an association between mandibular retrognathia and maxillary constriction in pediatric OSA, the overall relationship between specific craniofacial features and the condition remains inconclusive. Orthodontic interventions, such as rapid maxillary expansion, mandibular advancement devices, and maxillary protraction, have shown short-term improvements in sleep parameters, signs, and symptoms in selected cases. The stability of these changes is still unknown. However, there is currently no substantial evidence to support using these interventions as primary management options for pediatric obstructive sleep apnea (OSA). There is less debate regarding orthodontists' participation in screening for high-risk pediatric obstructive sleep apnea (OSA) and facilitating timely referrals. While screening for tonsillar and adenoidal hypertrophy and subsequent referral is a crucial function, this process should also include using validated sleep questionnaires, not solely relying on the assessment of craniofacial characteristics. Overall, there's a clear need for improved collaborative assessment and management strategies. Future research should prioritize long-term outcomes and the identification of phenotypic subgroups most likely to benefit from orthodontic intervention within the context of pediatric OSA.