Ped e iat a r t i r c c S lee e p e A p A nea e a Surg r er e y
|
|
- Blaise Harvey
- 6 years ago
- Views:
Transcription
1 Airway Imaging in Pediatric OSA Kasey Li, MD, DDS, FACS Stanford University Sleep Medicine Program The airway is smaller in children with OSA compared to controls The adenoid and tonsils are larger and the airway is most restricted where adenoid and tonsils overlap The volume of adenotonsillar tissues correlates with AHI Arens R, et al. Am J Respir CCM 2003;167: Arens R, et al. Am J Respir CCM 2001;164: Tonsillectomy/Adenoidectomy Surgical Outcomes The cure rate of T&A for OSA is 80% patients cumulative data from 11 studies RDI > 19 was more likely to have Post-op op RDI > 5 Shen et al. Arch Oto H N Surg 1995;44:51. Obese children, positive family history of OSA and African American Children are at high risk for having residual OSA after T&A Morton S, et al. Sleep 2001;24:823. 1
2 Surgical Outcomes 110 children with OSA underwent T&A 25% children achieve AHI 1, 46% AHI <5, 29% had AHI 5 Obesity and AHI are the major determinant for outcome Tauman R, et al. J Pediatr 2006;149: Singulair and CPAP are treatment options for children with persistent OSA following T&A Interview of Dr. David Gozal Recurrence 23 pubertal & postpubertal teenagers w/ prior T&A 5 subjects (all boys) reported snoring, 3 with OSA Mandibular deficiency/diminished posterior airway seen with the OSA patients Guilleminault C, et al. J Pediatrics 114;997, subjects followed 12 years after T&A (20 controls) Increased snoring in the T&A group (50% vs. 20%) Greater inspiratory effort in the T&A group in PSG Diminished airway space persists 12 years after T&A Tasker C, et al. Arch Dis Child 86;34, CPAP Retrospective study - 79 Children (6 mo-18 yr) 65 (82%) accepted CPAP, (34 took days) 6-12 yr > yr > below 6 yr Mean follow up 207 days (8-979 days) 50 (mean age 10 yr) had objective data (counter) 78% had complicating medical disorder 76% used CPAP at least half the days ( 1 hr) Mean daily use 4.7 hrs 5 yo 7.2 hrs, 6-12 yo 4.2 hrs, yo 3.6 hrs O Donnell AR, et al. Sleep 29; , 658, CPAP Retrospective study - 46 Children (7-19 yr) Mean age 13.6, mean BMI 39.8 (29 obese, 6 Down) 27/46 (59%) pts had objective data Mean follow up 18.1 mo (3-43 mo) 19/27 (70%) compliant (adult criteria) Parents over estimated usage 4 hrs 2 hrs > 4 hrs 0.5 hrs Uong EC, et al. Pediatrics 120;e , 11,
3 CPAP Prospective study - 29 children (2-16 yr) at 3 centers Randomly assigned CPAP/BiPAP 8 (28%) dropped out in 6 mos 21 with objective/subjective data Mean nightly use 5.3 ± 2.5 hrs Parents over estimated use (7.6 hrs vs 5.8 hrs) 78% of parents admitted that CPAP not used nightly Subjective improvement in daytime sleepiness High drop out rate/suboptimal use Marcus CL, et al. Pediatrics 117;e442-51, & Nasal Obstruction Nasal obstruction is a risk factor for SDB in children Urschitz, et al. Chest 126:790, Corbo GM, et al. Pediatrics 108:1149, Anuntaseree W, et al. Pediatr Pulmonl 32:222, Treatment of nasal obstruction improves SDB Mansfield LE, et al. Ann Allergy 92:240, Nixon GM, et al. Am J Respir Med 1:159, Nasal obstruction leads to increased nasal resistance and mouth breathing, which can negatively affect facial growth McNamara JA. Angle Orthod 50:269, Harvold EP, et al. Am J Orthod 79:359, Turbinate Reduction by RF 10 patients (15 mm electrode w/ 2 lesions) Improvement: 75%, (L) 68% No prescription pain meds needed 8/9 patients w/ preop meds were discontinued Laryngoscope 109:683, patients (15 mm electrode w/ 2 lesions) Improvement: severity 86%, frequency 94% No adverse effect on nasal physiology Evaluation: VAS, acoustic rhinometry, rhinomanometry, butanol threshold test, sacchrine test, olfaction, ciliary beat frequency Laryngoscope 111:153, patients (10 mm electrode w/ 3 lesions) Improvement (VAS): obstructin (7-3) Evaluation: acoustic rhinometry, sacchrine, ciliary test Laryngoscope 111:894,2001. Stanford Sleep Disorders Clinic experience Adenotonsillectomy/Pharyngoplasty Pharyngoplasty/Turbinate reduction N=189, mean age 9.8 ( years) Tonsils: 9-1+, 97-2+, 76-3+, 7-4+ All patients underwent T&A/pharyngoplasty 86 patients underwent RF turbinate reduction One patient with minor bleeding 10 days postop secondary to severe coughing-no no tx 330 (87.3%) tonsillar wounds remained completely closed 3
4 Stanford Sleep Disorders Clinic experience Improvement of turbinate size 2.98 ± 0.99 to 0.91 ± minor crusting Bleeding rate - 0.5% Control of bleeding 0% Dehydration 0% Readmission 0% Airway Involvement 26 snoring children studied by PSG and 26 controls 96.2% of OSA children are mouth breathers Vertical facial growth pattern identified in OSA group Retroposition and postinclination of the mandible 69% w/ labial incompetence and 52% w/ crossbite in OSA group, none in controls Diminished nasopharyngeal airway (enlarged adenoids) in OSA group Zucconi M, et al. Eur Respir J 13;411, OSA children have craniofacial abnormalities (increase ant. lower facial height, retrognathic mandible ) Kawashina S, et al. Acta Paediatr 91;71,
5 Maxillary Morphology 40 OSA patients and 21 controls Dental casts, cephalometrics evaluated 50% of OSA patients vs. 5% of controls with posterior transverse discrepancies OSA patients have narrower, more tapered and shorter maxillary arch Seto BH, et al. Eur J Orthod 23;703; Maxillary Morphology 13 patients with Marfan s syndrome (high arch palate) and 13 controls Maxilla significantly narrower (ICD, IPD, IMD) in Marfan s group Nasal resistance abnormal in 12 Marfan s and 4 controls Mean nasal resistance was doubled in Marfan s group 7 in Marfan s group with OSA, none in controls Cistulli PA, et al. Chest 110:1184, Nasal Airway & Rapid Maxillary Expansion Retrospective review of 10 children ( y.o ) with h/o nocturnal enuresis who underwent RME All patients with nasal obstruction NE improved, nasal breathing (subjective) improved in all patients Timms DJ. Angle Orthod 60:229, Prospective study of 10 children (8-13 y.o) with NE Six patients are mouth breathers, 8 Class II, 1 crossbite NE improved in 7 patients, nasal resistance improved in all Kurol J, et al. Angle Orthod 68:225, Nasal Airway & Rapid Maxillary Expansion Retrospective review of 237 patients 91% improvement (subjective) of nasal breathing Timms DJ. L Laryngol Otol 98:357, Prospective study of 26 patients (age 10-20) with RME Nasal resistance evaluated by rhinomanometry Amount of expansion 5-9 mm (1 st molar) Reduction of resistance in all (mean 36% improvement) Weak correlation between improvement and expansion Timms DJ. Br J Orthod 13;221,
6 Rapid Maxillary Expansion Prospective Study w/ 10 OSA patients (range y.o) All have maxillary constriction w/ dental crowding 6 patients w/ surgically assisted RME Mean expansion 12.1 mm at the appliance 9/10 patients improved (RDI 19 to 7, LSAT 89% to 91%) Cistulli PA, et al. Sleep 21:831, Rapid Maxillary Expansion Prospective Study of 31 children with OSA 19 boys, mean age 8.7 years, mean AHI 12.2 ( yo) Maxillary constriction, no adenotonsillar hypertrophy 22 had prior T & A 9 Class I, 14 Class II and 8 Class III RME- mean expansion 4.32 mm All had increased nasal resistance (26 bi-, 5 unilateral) Decrease in nasal resistance in all children AHI < 1 in all children Pirelli, Saponjara, Guilleminault. Sleep 27:761, Orthopedic effect of RME w/ maxillary processes opening in a triangular fashion-base at the palatal vault Am J Orthod Dentofac Orthop 107:268,
7 Orthodontic Expansion 16 successively treated children mean age 7.9 years, with a combination of enlarged tonsils (grade 2+ and 3+) and clinically narrow maxilla were involved in the study. All children were seen by Pediatric sleep specialist, Otolaryngologist, Oral/Maxillofacial surgeon and Orthodontist Pre R.M.E 2.6mm Post R.M.E 8.3mm 7
8 Results Variables Pre Post Mean AHI 12.2 ± ±3.7 Mean RDI 21 ± ± 5.1 Lowest SaO 2 92 ± ± 2.2 TST (min.) 421 ± ±17 Before After 8
9 Surgery Airway and Maxillomandibular Expansion 9
10 Patien t MME by Distraction Osteogenesis for OSA Guilleminault and Li. Laryngoscope 114:893, 2004 Sex Age Pre RDI Post RDI Pre Pes Post Pes Pre O2 Post O2 Size (mm) F/U (mo) 1 F M M M M F Mean Maxillomandibular Advancement Adult MMA Data 50/50 (100%) success rate Mean age 42.7 years Mean BMI changed from 30.7 to 28.6 Mean RDI improved from 59.2 to 4.7 Mean LSAT improved from 72.7% to 88.6 Chest 1999; 116: /20 (75%) success rate Mean age 45 years Mean BMI changed from 26.9 to 25.4 Mean RDI improved from 59 to 11 Mean LSAT improved from 82% to 90% Am J Respir Crit Care Med 2000;162:
11 Adult MMA Results Retrospective review 320 patients 306 patients (95%) with postop PSG 272 patients had preoperative RDI > 30 Age: 45.0 ± 9.5 years BMI: 32.7 ± 6.7 kg/m 2 RDI: 63.6 ± 26.7 to 10.5 ± 10.0 LSAT: 71.5 ± 15.1% to 86.9 ± 6.7% Success rate: 273 patients (89%) Adult MMA Results 33 patients (11%) are incomplete responder Age: 45.0 ± 7.3 years BMI: 35.0 ± 7.2 kg/m 2 RDI: 64.1 ± 25.2 to 32.2 ± 11.4 LSAT: 70.7 ± 16.5% to 81.5 ± 6.7% 32 patients in severe category pre-op 17 patients in severe category post-opop Adult MMA Results 502 MMA results evaluated Retrospective data 306 patients Prospective data 196 patients No mortality 88% success rate RDI < 20 and/or at Least a Reduction in RDI of 50% SaO2 > 90% or a Minimum Fall Below 90% Quality of life improvement 9 children (7 boys) persistent OSA All non-obese, obese, non-syndromic Mean age 14.7 ± 2 ( yr) Mean RDI 26.7 ± 17.5 (9-65.6) Mean LSAT 89.8 ± 1.2% (88-91%) CPAP recommended as initial tx 3 refused CPAP and 6 failed CPAP 7 MMA, 2 mandibular advancement 11
12 Variables Pre-Tx Post-Tx RDI 26.7 ± ± 3.1 Lowest SaO ± ± 1.3 No complications encountered Daytime fatigue and sleepiness improved in all patients but two patients continue to have residual symptoms Follow up 26.7 ± 17.5 months Case Presentation #1 16 year old boy Long history of daytime fatigue. Does not remember when he is not tired. Behavior problems and lives with grandparents Currently undergoing orthodontia Adenotonsillectomy at age 6 PSG RDI 65.6 events per hour LSAT 90% Case Presentation 12
13 Case Presentation #2 10 year old boy Long history of daytime fatigue. Behavior, social and school problems PSG RDI 22 events per hour LSAT 89% Struggling with PAP for the past 4 years 13
14 Case Presentation #3 15 year old girl with significant daytime fatigue and tiredness for years. 7 years of orthodontic therapy PSG RDI 62 events per hour LSAT 84% CPAP recommended and initiated Mother/patient elected to proceed with MMA ASAP after 4 months of CPAP 14
15 Surgical Outcomes Case #1: PSG: RDI-1, LSAT 94% Improvement of quality of sleep as well daytime fatigue Case #2: PSG: RDI-2, LSAT 92% Improvement of behavior, social and school issues Case #3: PSG: RDI-6, LSAT 92% Resolution of all symptoms Conclusions Significant number of pediatric patients have continual problems and symptoms following Adenotonsillectomy Many children are unable to tolerate CPAP Most children are suboptimally treated with CPAP therapy Improvement of nasal airway by RF turbinate reduction, skeletal expansion by orthodontic or surgery provide additional treatment options for patients beyond adenotonsillectomy 15
Pediatric OSA. Pediatric OSA: Treatment Options Beyond AT. Copyright (c) 2012 Boston Children's Hospital 1
Pediatric OSA Treatments Options Beyond AT Report of Financial Relationships (past 12 months) with commercial entities producing, marketing, re selling, or distributing health care goods or services consumed
More informationSuchada Sritippayawan, MD Div. Pulmonology & Critical Care Dept. Pediatrics, Faculty of Medicine
Management of pediatric OSA Suchada Sritippayawan, MD Div. Pulmonology & Critical Care Dept. Pediatrics, Faculty of Medicine Chulalongkorn University Treatment modalities Surgery Medications NIV during
More informationBrian Palmer, D.D.S, Kansas City, Missouri, USA. April, 2001
Brian Palmer, D.D.S, Kansas City, Missouri, USA A1 April, 2001 Disclaimer The information in this presentation is for basic information only and is not to be construed as a diagnosis or treatment for any
More informationEfficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up
Sleep Breath (2011) 15:179 184 DOI 10.1007/s11325-011-0505-1 ORIGINAL ARTICLE Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up Maria Pia Villa
More informationQuestions: What tests are available to diagnose sleep disordered breathing? How do you calculate overall AHI vs obstructive AHI?
Pediatric Obstructive Sleep Apnea Case Study : Margaret-Ann Carno PhD, CPNP, D,ABSM for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee April 2014. Facilitator s guide Part
More informationPediatric Obstructive Sleep apnea An update What else is there to know?
Pediatric Obstructive Sleep apnea An update What else is there to know? Garani S. Nadaraja, MD, FAAP Medical Director BCH-Oakland Clinical Assistant Professor Division of Pediatric Otolaryngology UCSF
More informationAbbreviations: ADH: antidiuretic hormone ADHD: attention-deficit hyperactivity disorder ANP: atrial natriuretic peptide BNP: brain natriuretic
Abbreviations: ADH: antidiuretic hormone ADHD: attention-deficit hyperactivity disorder ANP: atrial natriuretic peptide BNP: brain natriuretic peptide HRQoL: health-related quality of life OSAS: obstructive
More informationComplications of Sleep-Disordered Breathing
Complications of Sleep-Disordered Breathing Similarities between Pediatrics and Adults CATHERINE KIER, MD Professor of Clinical Pediatrics Division Chief, Pediatric Pulmonary, and Cystic Fibrosis Center
More informationPediatric Sleep Disorders
Pediatric Sleep Disorders S. SHAHZEIDI, MD, FAAP, FCCP, FAASM GRAND HEALTH INSTITUTE Objectives Discuss the importance of screening for snoring Explain the signs and symptoms of parasomnias and sleep apnea
More informationObstructive Sleep Apnea- Hypopnea Syndrome and Snoring: Surgical Options
Obstructive Sleep Apnea- Hypopnea Syndrome and Snoring: Surgical Options Joshua L. Kessler, MD, FACS Boston ENT Associates Clinical Instructor, Otology and Laryngology Harvard Medical School Why Consider
More informationCollege & Hospital, DPU Vidyapeeth Pimpri, Pune, India. *Corresponding Author:
Original Research Article DOI: 10.18231/2278-3784.2017.0001 Evaluation of changes in maxillary arch dimensions, Posterior Transverse Inter Arch Discrepancy (PTID), upper and lower incisor inclination in
More informationOBSTRUCTIVE SLEEP APNEA and WORK Treatment Update
OBSTRUCTIVE SLEEP APNEA and WORK Treatment Update David Claman, MD Professor of Medicine Director, UCSF Sleep Disorders Center 415-885-7886 Disclosures: None Chronic Sleep Deprivation (0 v 4 v 6 v 8 hrs)
More informationSurgical Treatment of OSA. Han-Soo Bae, MD Monroe Ear Nose and Throat Associates May 5, 2017
Surgical Treatment of OSA Han-Soo Bae, MD Monroe Ear Nose and Throat Associates May 5, 2017 Disclosure None Treatment of OSA PAP Oral appliance Surgery OSA and Mortality Surgical Treatment of OSA Surgery
More informationAn update on childhood sleep-disordered breathing
An update on childhood sleep-disordered breathing แพทย หญ งวนพร อน นตเสร ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร มหาว ทยาล ยสงขลานคร นทร Sleep-disordered breathing Primary snoring Upper airway resistance syndrome
More information11/19/2012 ก! " Varies 5-86% in men 2-57% in women. Thailand 26.4% (Neruntarut et al, Sleep Breath (2011) 15: )
Snoring ก Respiratory sound generated in the upper airway during sleep that typically occurs during inspiration but may occur during expiration ICSD-2, 2005..... ก ก! Prevalence of snoring Varies 5-86%
More informationClinical Study Changes in the Upper and Lower Pharyngeal Airway Spaces Associated with Rapid Maxillary Expansion
International Scholarly Research Network ISRN Dentistry Volume 2012, Article ID 290964, 5 pages doi:10.5402/2012/290964 Clinical Study Changes in the Upper and Lower Pharyngeal Airway Spaces Associated
More informationAirway and Airflow Characteristics In OSAS
Airway and Airflow Characteristics In OSAS 16 th Annual Advances in Diagnostics and Treatment of Sleep Apnea and Snoring February 12-13, 2010 San Francisco, CA Nelson B. Powell M.D., D.D.S. Adjunct Clinical
More informationPEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA)
PEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA) DEFINITION OSA Inspiratory airflow is either partly (hypopnea) or completely (apnea) occluded during sleep. The combination of sleep-disordered breathing with daytime
More informationPositive Airway Pressure Systems for Sleep Disordered Breathing
Positive Airway Pressure Systems for Sleep Disordered Breathing Lori Pickrell, RRT Account Manager Roberts Home Medical Lpickrell@robertshomemedical.com Objectives Upon completion of the session, attendees
More informationPolysomnography (PSG) (Sleep Studies), Sleep Center
Policy Number: 1036 Policy History Approve Date: 07/09/2015 Effective Date: 07/09/2015 Preauthorization All Plans Benefit plans vary in coverage and some plans may not provide coverage for certain service(s)
More informationCHALLENGES IN PEDIATRIC OBSTRUCTIVE SLEEP APNEA. Amy S. Whigham, MD Assistant Professor
CHALLENGES IN PEDIATRIC OBSTRUCTIVE SLEEP APNEA Amy S. Whigham, MD Assistant Professor Disclosures I have nothing to disclose. Outline Epidemiology Diagnosis Adenotonsillectomy Failure Treatment of Refractory
More informationAlexandria Workshop on
Alexandria Workshop on 1 Snoring & OSA Surgery Course Director: Yassin Bahgat MD Claudio Vicini MD Course Board: Filippo Montevecchi MD Pietro Canzi MD Snoring & Obstructive ti Sleep Apnea The basic information
More informationPre-Intervention OSA measure 12 previously diagnosed with OSA (details not provided) AHI mean 22.3 Mean Sp02: 93.7%
Coeugniet et al. 3 2014 Mitsukawa et al. 4 2013. Filiaci et al. 5 2013. Nout et al. 6 2012. 12-5 Apert 5 Crouzon 2 Pfeiffer 11-4 Crouzon 3 Pfeiffer 4 2 Crouzon 1 Apert 9-5 Crouzon All patients with known
More informationPEDIATRIC SLEEP GUIDELINES Version 1.0; Effective
MedSolutions, Inc. Clinical Decision Support Tool Diagnostic Strategies This tool addresses common symptoms and symptom complexes. Requests for patients with atypical symptoms or clinical presentations
More informationIbelieve the time has come for the general dentists to
EARLY ORTHODONTIC TREATMENT Brock Rondeau, D.D.S. I.B.O., D.A.B.C.P., D-A.C.S.D.D., D.A.B.D.S.M., D.A.B.C.D.S.M. Ibelieve the time has come for the general dentists to get serious and educated in an effort
More informationA Matter of Life and Breath
SSpecial P EReport: C I AA Matter L RofELifePandOBreath RT A Matter of Life and Breath By Paul R. White, D.D.S. 804.715.1998 www.smilerichmond.com 804.715.1998 www.smilerichmond.com 1 Not to be overly
More informationOSA in children. About this information. What is obstructive sleep apnoea (OSA)?
About this information This information explains all about sleep-related breathing problems in children, focusing on the condition obstructive sleep apnoea (OSA). It tells you what the risk factors are
More informationSurgical Options for the Successful Treatment of Obstructive Sleep Apnea
Surgical Options for the Successful Treatment of Obstructive Sleep Apnea Benjamin J. Teitelbaum, MD, FACS Otolaryngology Head and Neck Surgery Saint Agnes Medical Center Fresno, California Terms Apnea
More informationObstructive sleep apnea (OSA)
Obstructive sleep apnea (OSA) In a healthy sleeping child, the mouth is typically closed, the oral cavity is collapsed, and the nasopharynx and hypopharynx are patent with minimal wall motion Obstructive
More informationTreatment Outcomes of Adenotonsillectomy for Children with Obstructive Sleep Apnea: A Prospective Longitudinal Study
TREATMENT OUTCOMES OF ADENOTONSILLECTOMY FOR CHILDREN WITH OSA http://dx.doi.org/10.5665/sleep.3310 Treatment Outcomes of Adenotonsillectomy for Children with Obstructive Sleep Apnea: A Prospective Longitudinal
More informationChanges of the Transverse Dental Arch Dimension, Overjet and Overbite after Rapid Maxillary Expansion (RME)
Dental Journal Changes of the Transverse Dental Arch Dimension, Overjet and Overbite after Rapid Maxillary Expansion (RME) Department of Advanced General Dentistry Faculty of Dentistry, Mahidol University.
More informationUpdate on sleep disorders in children
Update on sleep disorders in children CATHERINE KIER, MD Professor of Clinical Pediatrics Division Chief, Pediatric Pulmonary, and Cystic Fibrosis Center Director, Pediatric Sleep Disorders Center SUNY
More informationA comparative study of adult and pediatric polysomnography
International Journal of Otorhinolaryngology and Head and Neck Surgery Athiyaman K et al. Int J Otorhinolaryngol Head Neck Surg. 2018 May;4(3):630-635 http://www.ijorl.com pissn 2454-5929 eissn 2454-5937
More informationBruxism: Revisiting an Old Problem with New Questions and Unique Solutions
Jeff Rouse, DDS Txacad@aol.com 555 E. Basse #200 www.coredentistry.com San Antonio, TX 78209 210-828-3334 Bruxism: Revisiting an Old Problem with New Questions and Unique Solutions CORE Concept Wear and
More informationPalatal Depth and Arch Parameter in Class I Open Bite, Deep Bite and Normal Occlusion
26 Iraqi Orthod J 1(2) 2005 Palatal Depth and Arch Parameter in Class I Open Bite, Deep Bite and Normal Occlusion Ahmad A. Abdulmawjood, a Mahmood K. Ahmed, a and Ne am R. Al-Saleem a Abstract: This study
More informationObstructive Sleep Disordered Breathing in children and Growth
Obstructive Sleep Disordered Breathing in children and Growth Diana Marangu Kenya Paediatric Association Respiratory Symposium Wednesday, 26 th April 2017 Outline Obstructive sleep disordered breathing
More informationSleep Disordered Breathing
Sleep Disordered Breathing SDB SDB Is an Umbrella Term for Many Disorders characterized by a lack of drive to breathe Results n repetitive pauses in breathing with no effort Occurs for a minimum of 10
More informationCase Report: Long-Term Outcome of Class II Division 1 Malocclusion Treated with Rapid Palatal Expansion and Cervical Traction
Case Report Case Report: Long-Term Outcome of Class II Division 1 Malocclusion Treated with Rapid Palatal Expansion and Cervical Traction Roberto M. A. Lima, DDS a ; Anna Leticia Lima, DDS b Abstract:
More informationSnoring And Sleep Apnea in the U.S. Definitions Apnea: Cessation of ventilation for > 10 seconds. Defining Severity of OSA
Snoring and Obstructive Sleep Apnea: Oral Appliance Therapy Management Midwest Society of Orthodontists October 16-17, 2009 Anthony J DiAngelis DMD, MPH Chief, Department of Dentistry, HCMC Professor,
More informationMandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome
DOI 10.1007/s11325-011-0595-9 REVIEW Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome Maria Pia Villa & Silvia Miano & Alessandra Rizzoli
More informationDisclosures. Learning Objectives. Obstructive sleep apnea and snoring 3/19/2014. None
Obstructive sleep apnea and snoring Ashutosh Kacker, MD, FACS Professor of Clinical Otolaryngology Department of Otorhinolaryngology Weill Medical College of Cornell University New York Presbyterian Hospital
More informationJust sleep apnoea? R.L. Riha. Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK. Correspondence
Patient Case A 17-yr-old man presented to the clinic with his mother after crashing his car. He had fallen asleep at the wheel and been referred urgently by his general practitioner. He had driven for
More informationOrthodontics and Obstructive Sleep Apnea in Children
Orthodontics and Obstructive Sleep Apnea in Children Paola Pirelli, DDS a,b, *, Maurizio Saponara, MD c, Chiara De Rosa, DDS a, Ezio Fanucci, MD d KEYWORDS Obstructive sleep apnea syndrome Rapid maxillary
More informationSANDHYA CA SHYAM LOHAKARE Professor, Orthodontics Department, Chattisgarh Dental College & Research Centre, Rajnandgaon, C.G
International Journal of Applied and Natural Sciences (IJANS) ISSN(P): 2319-4014; ISSN(E): 2319-4022 Vol. 5, Issue 6, Oct Nov 2016; 49-58 IASET CEPHALOMETRIC STUDY OF UPPER AND LOWER PHARYNGEAL AIRWAYS
More informationManagement of OSA. saurabh maji
Management of OSA saurabh maji INTRODUCTION Obstructive sleep apnea is a major public health problem Prevalence of OSAS in INDIA is 2.4% to 4.96% in men and 1% to 2 % in women In the rest of the world
More informationSleep apnea and bruxism
Sleep disordered breathing (SDB) Sleep apnea and bruxism CAPD-ACDP 2014 Annual Meeting, Montreal Increasing upper airway collapsibility Occasional snoring Habitual snoring Upper airway resistance syndrome
More informationMaxillary Expansion and Protraction in Correction of Midface Retrusion in a Complete Unilateral Cleft Lip and Palate Patient
Case Report Maxillary Expansion and Protraction in Correction of Midface Retrusion in a Complete Unilateral Cleft Lip and Palate Patient Masayoshi Kawakami, DDS, PhD a ; Takakazu Yagi, DDS, PhD b ; Kenji
More information11/13/2017. Jeremy Tabak MD, FAASM Medical Director Baptist Hospital Sleep Lab Medical Director Baptist Sleep Lab at Galloway
Jeremy Tabak MD, FAASM Medical Director Baptist Hospital Sleep Lab Medical Director Baptist Sleep Lab at Galloway HypnoLaus study: OSA effect on mortality US Preventive Services Task Force recommendations
More information11/20/2015. Eighth Biennial Pediatric Sleep Medicine Conference. November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida
Eighth Biennial Pediatric Sleep Medicine Conference November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida Manisha Witmans, MD, FRCPC, FAASM Associate Clinical Professor, University
More informationSleep Medicine xxx (2013) xxx xxx. Contents lists available at SciVerse ScienceDirect. Sleep Medicine. journal homepage:
Sleep Medicine xxx (2013) xxx xxx Contents lists available at SciVerse ScienceDirect Sleep Medicine journal homepage: www.elsevier.com/locate/sleep Critical role of myofascial reeducation in pediatric
More informationThe impact of rapid palatal expansion on children s general health: a literature review
M. Eichenberger, S. Baumgartner Department of Orthodontics and Paediatric Dentistry University of Zürich, Switzerland e-mail: Stefan.Baumgartner@zzm.uzh.ch The impact of rapid palatal expansion on children
More informationDiagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome Director, Sleep Laboratory Center for Pediatric Sleep Disorders Boston Children s Hospital Copyright 2014 Boston Children s Hospital
More informationsleep apnea syndrome (OSAS) in young, growing patients, resulting in an overall, life-changing health improvement.
CHANGING LIVES, Rapid palatal expansion Abstract Myriad articles indicate a possible link between maxillary constriction and airway resistance; this piece proposes to show how orthodontic treatment with
More informationSleep-Disordered Breathing in Children and a Critical Review of T&A. Objectives. No disclosures
Sleep-Disordered Breathing in Children and a Critical Review of T&A No disclosures Anna Meyer, MD, FAAP Pediatric Otolaryngology Otolaryngology-Head & Neck Surgery UCSF February 2014 1 Objectives Summarize
More informationPersistent Obstructive Sleep Apnea After Tonsillectomy. Learning Objectives. Mary Frances Musso, DO Pediatric Otolaryngology
Persistent Obstructive Sleep Apnea After Tonsillectomy Mary Frances Musso, DO Pediatric Otolaryngology Learning Objectives Recognize indications for tonsillectomy List patients at risk for persistent OSA
More informationBrazilian Journal of OTORHINOLARYNGOLOGY. Obstructive sleep apnea and primary snoring: treatment. Objective.
Braz J Otorhinolaryngol. 2014;80(1 Supl. 1):S17-S28 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org.br GUIDELINE Obstructive sleep apnea and primary snoring: treatment Authors Associação Brasileira
More informationNASAL CONTINUOUS POSITIVE AIRWAY PRESSURE FOR OBSTRUCTIVE SLEEP APNEA IN CHILDREN. Dr. Nguyễn Quỳnh Anh Department of Respiration 1
1 NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE FOR OBSTRUCTIVE SLEEP APNEA IN CHILDREN Dr. Nguyễn Quỳnh Anh Department of Respiration 1 CONTENTS 2 1. Preface 2. Definition 3. Etiology 4. Symptoms 5. Complications
More informationPediatric Considerations in the Sleep Lab
AAST Technologist Fundamentals Date: May 7, 2017 Focus Conference Location: Orlando, Florida Workshop Pediatric Considerations in the Sleep Lab By Joel Porquez, BS, RST/RPSGT, CCSH X X X X X X Conflict
More informationOffice location Objectives 5/1/2017. Pneumopedics and Craniofacial Epigenetics. Do I snore?
Pneumopedics and Craniofacial Epigenetics American Sleep and Breathing Academy Office location 2017 Dr. G. Dave Singh DDSc PhD DMD 2017 Vivos BioTechnologies, Inc. Professor Dr. G. Dave Singh DMD PhD DDSc
More informationOral Appliances and their Clinical Applications
Oral Appliances and their Clinical Applications Peter Cistulli MBBS, PhD, MBA, FRACP Professor of Respiratory Medicine & Head of Discipline of Sleep Medicine University of Sydney Director, Centre for Sleep
More informationJMSCR Vol 05 Issue 01 Page January 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i1.161 Risk of Failure of Adenotonsillectomy
More informationSURGERY FOR SNORING AND MILD OBSTRUCTIVE SLEEP APNOEA
SURGERY FOR SNORING AND MILD OBSTRUCTIVE SLEEP APNOEA INTRODUCTION Snoring with or without excessive daytime somnolence, restless sleep and periods of apnoea are all manifestations of sleep disordered
More informationPediatric Sleep-Disordered Breathing
Pediatric Sleep-Disordered Breathing OSA in infants and young children is generally characterized by partial, persistent obstruction of the upper airway Continuum Benign primary snoring Upper-airway resistance
More informationRapid Maxillary Expansion for Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis
The Laryngoscope VC 2016 The American Laryngological, Rhinological and Otological Society, Inc. Systematic Review Rapid Maxillary Expansion for Pediatric Obstructive Sleep Apnea: A Systematic Review and
More informationCase Report Orthodontic and Orthognathic Surgical Treatment of a Pediatric OSA Patient
Case Reports in Dentistry Volume 2016, Article ID 5473580, 7 pages http://dx.doi.org/10.1155/2016/5473580 Case Report Orthodontic and Orthognathic Surgical Treatment of a Pediatric OSA Patient Gregory
More informationDifferent Non Surgical Treatment Modalities for Class III Malocclusion
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861. Volume 9, Issue 6 (Sep.- Oct. 2013), PP 48-52 Different Non Surgical Treatment Modalities for Class III Malocclusion
More informationRole of Oral Devices in Managing Sleep-disordered Breathing Patients
Role of Oral Devices in Managing Sleep-disordered Breathing Patients Sleep-disordered breathing (SDB) includes mouth breathing, snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea
More informationTemperature controlled radiofrequency ablation for OSA
Temperature controlled radiofrequency ablation for OSA Ridhwan Y. Baba, M.B.B.S. *1, V.V.S. Ramesh Metta, M.B.B.S. 1, Arjun Mohan, M.B.B.S. 2, M. Jeffery Mador, M.D. 2 1 Department of Internal Medicine,
More informationERS Annual Congress Milan September 2017 Meet the expert ME1 Treating obstructive sleep apnoea syndrome in children
ERS Annual Congress Milan 09 13 September 2017 Meet the expert ME1 Treating obstructive sleep apnoea syndrome in children Sunday, 10 September 2017 13:00-14:00 Amber 7 + 8 (South) MICO You can access an
More informationA SIMPLE METHOD FOR CORRECTION OF BUCCAL CROSSBITE OF MAXILLARY SECOND MOLAR
Short Communication International Journal of Dental and Health Sciences Volume 01,Issue 03 A SIMPLE METHOD FOR CORRECTION OF BUCCAL CROSSBITE OF MAXILLARY SECOND MOLAR Sumit Yadav 1,Davender Kumar 2,Achla
More informationPediatric obstructive sleep apnea Adenotonsillectomy and beyond (a surgeon s perspective)
Pediatric obstructive sleep apnea Adenotonsillectomy and beyond (a surgeon s perspective) Tony Kille, MD Associate Professor Pediatric Otolaryngology American Family Children s Hospital Madison, WI Disclosures
More informationSleep Disorders and the Metabolic Syndrome
Sleep Disorders and the Metabolic Syndrome Tom V. Cloward, M.D. Intermountain Sleep Disorders Center LDS Hospital Objectives Describe how sleep disorders impact your daily medical practice Don Don t do
More information2016 Physician Quality Reporting System Data Collection Form: Sleep Apnea (for patients aged 18 and older)
2016 Physician Quality Reporting System Data Collection Form: Sleep Apnea (for patients aged 18 and older) IMPORTANT: Any measure with a 0% performance rate (100% for inverse measures) is not considered
More informationNasal Mass Presenting as Obstructive Sleep Apnea Syndrome
ORIGINAL ARTICLE pissn 2093-9175 / eissn 2233-8853 http://dx.doi.org/10.17241/smr.2015.6.2.54 Nasal Mass Presenting as Obstructive Sleep Apnea Syndrome Seung Hoon Lee, MD, PhD, In Sik Song, MD, Jae Woo
More informationOral Appliances and their Clinical Indications in OSA
Oral Appliances and their Clinical Indications in OSA Disclosures Andrew Chan, MB BS, PhD, FRACP, FCCP Staff Specialist, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, University
More informationRoles of Surgery in OSA MASM Annual Fall Conference 2017 October 14, 2017 Kathleen Yaremchuk, MD, MSA Chair, Department of Otolaryngology/Head and
Roles of Surgery in OSA MASM Annual Fall Conference 2017 October 14, 2017 Kathleen Yaremchuk, MD, MSA Chair, Department of Otolaryngology/Head and Neck Surgery Senior Staff Sleep Medicine Henry Ford Hospital
More informationTolerance of Positive Airway Pressure following Site-Specific Surgery of Upper Airway
34 The Open Sleep Journal, 2008, 1, 34-39 Open Access Tolerance of Positive Airway Pressure following Site-Specific Surgery of Upper Airway Ho-Sheng Lin *,#,1,2, Roger Toma #,2, Cara Glavin 2, Mark Toma
More informationEvaluation, Management and Long-Term Care of OSA in Adults
Evaluation, Management and Long-Term Care of OSA in Adults AUGUST 2015 Providing diagnostic tools and therapies that are evidence-based is a key part of a successful sleep practice. This resource outlines
More informationSleep Medicine. Teenage sleep-disordered breathing: Recurrence of syndrome
Sleep Medicine 14 (2013) 37 44 Contents lists available at SciVerse ScienceDirect Sleep Medicine journal homepage: www.elsevier.com/locate/sleep Original Article Teenage sleep-disordered breathing: Recurrence
More informationCorrelation Between Naso Labial Angle and Effective Maxillary and Mandibular Lengths in Untreated Class II Patients
9 International Journal of Interdisciplinary and Multidisciplinary Studies,2014,Vol 1,No.3,9-14. Available online at httt://www.ijims.com ISSN: 2348 0343 Correlation Between Naso Labial Angle and Effective
More informationThe most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome
The most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome Natsios Georgios University Hospital of Larissa, Greece Definitions Obstructive Sleep Apnea (OSA)
More informationSupplementary Online Content
Supplementary Online Content Marklund M, Carlberg B, Forsgren L, Olsson T, Stenlund H, Franklin KA. Oral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea:
More informationSleep Diordered Breathing (Part 1)
Sleep Diordered Breathing (Part 1) History (for more topics & presentations, visit ) Obstructive sleep apnea - first described by Charles Dickens in 1836 in Papers of the Pickwick Club, Dickens depicted
More informationNew Guidelines for Tonsillectomy Daniel C. Chelius, Jr., MD Pediatric Otolaryngolo Pediatric Otolary gy--head Head and Neck S and Neck u S rgery
New Guidelines for Tonsillectomy Daniel C. Chelius, Jr., MD Pediatric Otolaryngology-Head and Neck Surgery November 16, 2011 EXIT Procedures Sinus surgery/skull base surgery Head and Neck Cancers Thyroid/Parathyroid
More informationAdvancements in the Field of Dental Sleep Medicine
Advancements in the Field of Dental Sleep Medicine An update for sleep specialists & technologists Daniel Burton, DDS, D.ABDSM Dentist / Owner at Michigan Sleep Network, PC MASM Annual Meeting October
More informationMaxillary Growth Control with High Pull Headgear- A Case Report
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 01 Ver. X January. (2018), PP 09-13 www.iosrjournals.org Maxillary Growth Control with High
More informationMedicare C/D Medical Coverage Policy
Medicare C/D Medical Coverage Policy Surgical Treatment of Obstructive Sleep Apnea Origination: June 26, 2000 Review Date: January 18, 2017 Next Review January, 2019 DESCRIPTION OF PROCEDURE OR SERVICE
More informationNew Perspectives on the Pathogenesis of OSA - Anatomic Perspective. New Perspectives on the Pathogenesis of OSA: Anatomic Perspective - Disclosures
New Perspectives on the Pathogenesis of OSA - Anatomic Perspective Richard J. Schwab, M.D. Professor of Medicine Interim Chief, Division of Sleep Medicine Medical Director, Penn Sleep Centers University
More informationObstructive sleep apnea Is it time for personalized medicine?
Obstructive sleep apnea Is it time for personalized medicine? CATHERINE KIER, MD Professor of Clinical Pediatrics Division Chief, Pediatric Pulmonary, and Cystic Fibrosis Center Director, Pediatric Sleep
More informationSnoring and Obstructive Sleep Apnea: Patient s Guide to Minimally Invasive Treatments Chapter 6
Snoring and Obstructive Sleep Apnea: Patient s Guide to Minimally Invasive Treatments Chapter 6 MINIMALLY INVASIVE TREATMENTS OF SNORING AND SLEEP APNEA OVERVIEW The past decade has seen the rise of effective,
More informationin China Shanghai Office Beijing Office (+86) (+86)
SLEEP Apnea in China Guide 2018-2019 Shanghai Office (+86) 21 2426 6400 Beijing Office (+86) 010 6464 0611 www.pacificprime.cn Follow us on WeChat t A comprehensive overview of sleep apnea Perhaps you
More informationObstructive sleep apnea: A dentist update
Review article Obstructive sleep apnea: A dentist update Mithun K*, Ashith M V, Valerie Anithra Pereira, Deesha Kumari Email:dr.mithunknaik@gmail.com Abstract Sleep breathing disorder includes snoring,
More informationRESEARCH PACKET DENTAL SLEEP MEDICINE
RESEARCH PACKET DENTAL SLEEP MEDICINE American Academy of Dental Sleep Medicine Dental Sleep Medicine Research Packet Page 1 Table of Contents Research: Oral Appliance Therapy vs. Continuous Positive Airway
More informationPaediatric Sleep-Disordered Breathing and Orthodontics
Paediatric Sleep-Disordered Breathing and Orthodontics Vandana Katyal Discipline of Orthodontics School of Dentistry Faculty of Health Sciences The University of Adelaide Australia 2013 A research thesis
More informationObjectives. Myofunctional Therapy is not speech therapy. Myofunctional Therapy. Conclusion: My Simple Premise 9/15/15
Myofunctional Therapy, An Evidenced Based Treatment for ADD/ADHD and More Without the Use of Medication My Simple Premise Martin Denbar, DDS General Dentist Diplomate, American Board of Dental Sleep Medicine
More informationPediatric Airway Disorders Speaker Disclosure Outline
Pediatric Airway Disorders G. Paul Digoy, M.D. Director of Pediatric Otolaryngology OU Health Sciences Center Paul-Digoy@ouhsc.edu Office: 405 271-5504 Speaker Disclosure Speakers, moderators, or panelists
More informationIn-Patient Sleep Testing/Management Boaz Markewitz, MD
In-Patient Sleep Testing/Management Boaz Markewitz, MD Objectives: Discuss inpatient sleep programs and if they provide a benefit to patients and sleep centers Identify things needed to be considered when
More informationSLEEP DISORDERED BREATHING QUESTIONNAIRES
SLEEP DISORDERED BREATHING QUESTIONNAIRES By Earl O. Bergersen, DDS, MSD for Young Children Sleep Disordered Breathing (SDB) has been researched for many years for the adult, however, interest in sleep
More information