Department of Orthodontics, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA 02111, USA.
Department of Orthodontics, University of Illinois College of Dentistry, 801 S. Paulina Street, IL 60612, USA.
Dent Clin North Am. 2024 Jul;68(3):475-483. doi: 10.1016/j.cden.2024.03.005. Epub 2024 May 18.
Obstructive sleep apnea (OSA) can affect children and adults, and, if left untreated, could have a major impact on the general and overall well-being of the patient. Dental health care providers and orthodontists have an interdisciplinary role in screening patients at risk for OSA and make a referral to establish a definitive diagnosis by a sleep physician. The gold standard of diagnostic testing is polysomnography. The adeno-tonsillar hypertrophy is the primary cause of sleep apnea in children; therefore, adeno-tonsillectomy must be the first line of treatment. Post adeno-tonsillectomy, if there is residual OSA due to underlying skeletal discrepancy, the patient may be referred to an orthodontist for appropriate management. Currently the evidence in the literature for prophylactic growth modification in children to prevent OSA is weak. In adults, the gold standard for managing OSA is Positive Airway Pressure (PAP) therapy; however, adherence to this treatment is rather low. The oral appliance (OA) therapy is an alternate for PAP intolerant patients and for mild to moderate OSA patients. The OA therapy has to be administered by a qualified dentist or orthodontist after careful examination of dental and periodontal health as well as any pre-existing joint conditions. The OA therapy could cause OA-associated malocclusion and patients have to be made aware of prior to initiating treatment. In patients with severe OSA, surgical maxilla-mandibular advancement (MMA) is highly effective.
阻塞性睡眠呼吸暂停（OSA）可影响儿童和成人，如果不加以治疗，可能会对患者的整体健康产生重大影响。牙科保健提供者和正畸医生在筛查有 OSA 风险的患者方面具有跨学科作用，并转介给睡眠医生以建立明确的诊断。诊断测试的金标准是多导睡眠图。腺样体扁桃体肥大是儿童睡眠呼吸暂停的主要原因；因此，腺样体扁桃体切除术必须是一线治疗方法。腺样体扁桃体切除术后，如果由于潜在的骨骼差异仍存在 OSA，则患者可能会被转介给正畸医生进行适当的治疗。目前，针对预防儿童 OSA 的预防性生长矫正的文献证据较弱。对于成年人，管理 OSA 的金标准是正压通气（PAP）治疗；但是，这种治疗的依从性相当低。口腔矫治器（OA）治疗是 PAP 不耐受患者和轻度至中度 OSA 患者的替代治疗方法。OA 治疗必须由合格的牙医或正畸医生在仔细检查牙齿和牙周健康以及任何现有关节疾病后进行。OA 治疗可能会导致与 OA 相关的错合，在开始治疗前必须让患者了解这一点。对于严重 OSA 的患者，上颌下颌骨推进（MMA）手术非常有效。
