Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Sunday, November 7, 2010

Sleep Apnea Treatment in Children improves Performance and Behavior. Treacher-Collins syndrome is discussed in Cleft Palate Journal

I recently came across an older article on sleep apnea and Treacher-Collins syndrome. The article describes improvements in Behavior and performance after correction of micrognathia. What is startling is that the article was published almost 30 years ago long before most physicians worried about pediatric sleep apnea. We now know that 80% of ADD and ADHD children have sleep apnea. Scalloped tongues are indicative (80% predictive) of sleep apnea.

We now know that all snoring and even the mildest sleep apnea can never be ignored in children. It is a shame how many years were wasted with children waiting to outgrow tonsils or adenoids. If you read the story of my son on the main website I had to fight to have his airway corrected. Even seeking a sleep study was considered for Billy was considered crazy. Now it appears the literature supported treating airway obstructions in children several years prior to my experiences.

I have to wonder what other advances are being ignored or just unknown despite published literature.

I know that headache and pain treatment is currently grossly undertreated by neuromuscular dentistry despite the research and case studies. See http://www.ihateheadaches.org

Cleft Palate J. 1981 Jan;18(1):39-44.
Obstructive sleep apnea in Treacher-Collins syndrome.
Johnston C, Taussig LM, Koopmann C, Smith P, Bjelland J.

Studies of the Treacher-Collins syndrome have emphasized hearing and surgical considerations. Although craniofacial anomalies have been associated with respiratory disorders in infancy, the presence of such problems in older children has not been emphasized. An eight-year-old with Treacher-Collins syndrome presented a history of recent behavioral problems at home, poor attention span and performance in school, daytime somnolence, and sleep apnea with relatively long periods of chest movement but no airflow. He also had abnormal sleep behavior consisting of rocking to and fro on his hands and knees, often to such an extent that his nose became abraded. ICU monitoring with observation and recording of sleep patterns and sounds, and fluoroscopy of his upper airway utilizing cineradiography while asleep confirmed the diagnosis of obstructive sleep apnea. The patient subsequently underwent an orthognathic surgery consisting of insertion of rib bone grafts after anterior advancement of his mandible. This procedure resulted in disappearance of the obstructive sleep apnea and associated symptoms. Because of micrognathia, patients with Treacher-Collins syndrome are at high risk for developing obstructive sleep apnea. Surgical correction of their deformities can result in improvement in cosmetic appearance as well as in resolution of the obstructive episodes with improvement in performance and behavior.

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posted by Dr Shapira at 12:49 PM