Ikävalko Tiina, Närhi Matti, Eloranta Aino-Maija, Lintu Niina, Myllykangas Riitta, Vierola Anu, Tuomilehto Henri, Lakka Timo, Pahkala Riitta
Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
Oral and Maxillofacial Department, Kuopio University Hospital, Finland.
Eur J Orthod. 2018 May 25;40(3):268-272. doi: 10.1093/ejo/cjx056.
We studied longitudinally the associations of craniofacial morphology, mouth breathing, orthodontic treatment, and body fat content with the risk of having and developing sleep disordered breathing (SDB) in childhood. We hypothesized that deviant craniofacial morphology, mouth breathing, and adiposity predict SDB among children.
The participants were 412 children 6-8 years of age examined at baseline and 329 children aged 9-11 years re-examined at an average 2.2-year follow-up. An experienced orthodontist evaluated facial proportions, dental occlusion, soft tissue structures, and mode of breathing and registered malocclusions in orthodontic treatment. Body fat percentage was assessed by dual-energy X-ray absorptiometry and SDB symptoms by a questionnaire.
Children with SDB more likely had convex facial profile, increased lower facial height, mandibular retrusion, tonsillar hypertrophy, and mouth breathing at baseline and convex facial profile, mandibular retrusion, and mouth breathing at follow-up than children without SDB at these examinations. Male gender and body adiposity, mouth breathing, and distal molar occlusion at baseline were associated with SDB later in childhood. Adipose tissue under the chin, mandibular retrusion, vertically large or normal throat and malocclusion in orthodontic treatment at baseline predicted developing SDB during follow-up of among children without SDB at baseline.
We could not conduct polysomnographic examinations to define sleep disturbances. Instead, we used a questionnaire filled out by the parents to assess symptoms of SDB.
The results indicate that among children, deviant craniofacial morphology, mouth breathing, body adiposity, and male gender seem to have implications in the pathophysiology of SDB.
我们纵向研究了儿童颅面形态、口呼吸、正畸治疗和体脂含量与患睡眠呼吸障碍（SDB）及病情发展风险之间的关联。我们假设异常的颅面形态、口呼吸和肥胖是儿童睡眠呼吸障碍的预测因素。
研究对象包括412名6 - 8岁的儿童，在基线时接受检查，以及329名9 - 11岁的儿童，平均在2.2年的随访后接受复查。一名经验丰富的正畸医生评估面部比例、牙合关系、软组织结构和呼吸方式，并记录正畸治疗中的错牙合情况。通过双能X线吸收法评估体脂百分比，通过问卷评估睡眠呼吸障碍症状。
与在这些检查中无睡眠呼吸障碍的儿童相比，有睡眠呼吸障碍的儿童在基线时更可能有凸面型、面下高度增加、下颌后缩、扁桃体肥大和口呼吸，在随访时更可能有凸面型、下颌后缩和口呼吸。男性性别、基线时的身体肥胖、口呼吸和远中磨牙牙合与儿童后期的睡眠呼吸障碍有关。基线时下颌下脂肪组织、下颌后缩、垂直方向上较大或正常的咽部以及正畸治疗中的错牙合可预测基线时无睡眠呼吸障碍的儿童在随访期间会出现睡眠呼吸障碍。
我们无法进行多导睡眠图检查来定义睡眠障碍。相反，我们使用了一份由家长填写的问卷来评估睡眠呼吸障碍症状。
结果表明，在儿童中，异常的颅面形态、口呼吸、身体肥胖和男性性别似乎在睡眠呼吸障碍的病理生理学中具有重要意义。
