How many orthodontic patient have sleep disordered breathing?
Sleep disordered breathing (SDB) is a serious problem for children. This new paper provides us with information on the potential prevalence of SDB in a population of orthodontic patients.
The role of SDB in the aetiology of malocclusion is far from clear. However, there is little doubt that SDB can cause severe problems for children. For example, SDB leads to hyperactivity and this may be misdiagnosed as attention deficit disorder. As orthodontists mostly see children for treatment it is important that we identify those potential patients who have SDB. We can then refer them for appropriate treatment. The AJO-DDO published this paper and a team from Cleveland, Ohio did this study.
Ashok K. Rohra, et al
AJO-DDO Am J Orthod Dentofacial Orthop 2018;154:65-71 https://doi.org/10.1016/j.ajodo.2017.11.027
They set out to ask the following question
“What is the prevalence of SDB in children who present for orthodontic treatment”?
What did they do?
They did a screening study of 303 children who attended a dental school orthodontic clinic between January 2014 and March 2016. They included all children who had not had orthodontic treatment previously. Each patient completed the Paediatric Sleep Questionnaire (PSQ), which is a validated instrument that other investigators have used. Importantly, this questionnaire has reasonable accuracy when compared to polysomnography. They used the PSQ to identify patients who are likely to have SDB. This was a simple straightforward method of data collection.
What did they find?
They set a cut off point for SDB as 33% of yes responses to the questions. They found that 44% of the children had no SDB positive responses, but 7% were identified as being at clear risk of SDB.
Their overall conclusion was that SDB was a potential problem for a proportion of patients referred for orthodontic treatment. When they considered other data, other studies have suggested a prevalence of 0.7-13% of children have SDB. However, some of this variation may be due to different methods of measurement.
They also suggested that the average orthodontic practice in the USA may see 2-3 children with SDB per day.
Finally, they concluded that if orthodontists routinely screened their patients for SDB and referred those with SDB for treatment, they would provide a more comprehensive health care service.
What did I think?
I have often thought that the simplest studies are potentially the most useful because they ask a simple question using simple methods. This is one of those studies. The authors used a simple validated questionnaire and gave it to their patients. The findings are relevant to an orthodontic population. However, we need to consider that the population in a dental school clinic may be different from those referred to a private practice. But this is not a major shortcoming.
I was also pleased that the authors felt that the children at risk should be referred for relevant treatment. Importantly, they did not use this small sample to “go off” on a long diatribe about the benefits of orthodontic treatment for SDB.
Finally, it was nice to see a well written and simple study that has clinically relevant findings. I wonder if we should routinely use this method to screen our patients for SDB? Lets have a discussion.
Emeritus Professor of Orthodontics, University of Manchester, UK.