MIDFACIAL AND DENTAL CHANGES ASSOCIATED WITH POSITIVE AIRWAY PRESSURE IN CHILDREN AND ADOLESCENTS WITH SLEEP-DISORDERED BREATHING

Abstract

Introduction: The use of Positive Airway Pressure (PAP) for treatment of pediatric Sleep Disordered Breathing (SDB) is an increasingly widespread therapy that currently lacks longitudinal data to describe how mask pressure impacts the developing facial skeleton. Early reports have described a possible causal association between PAP usage and maxillary retrusion, but limited outcome reports and lack of established correlative assessment tools highlight the need for systematic research. The aims of this study were to examine the difference in midfacial growth between pediatric subjects with underlying craniofacial diagnoses that were prescribed PAP for SDB and were compliant vs. non-compliant with PAP therapy, and to explore correlations between demographic, medical, and sleep study variables with rate of annual facial change. Methods: This was a retrospective cohort study. Review of Craniofacial Center and Sleep Disorders Center records was performed to identify patients who were prescribed PAP for SDB with serial cephalographic images obtained as part of routine clinical care for concomitant craniofacial diagnosis. Lateral cephalometric analysis was used to determine mean annual change in midfacial structures from T1 to T2 in subjects with and without PAP compliance. Annual rate of change of cephalometric measurements for the compliant subjects were compared to non-compliant subjects. Results: 50 subjects (28 male, 22 female; mean age, 10.42) were compliant with PAP therapy (>20 hour/wk., >6 months) for an average of 2.57 years. The control group comprised 50 non-compliant subjects (29 male, 21 female; mean age, 8.53). Subjects who were compliant with PAP experienced negative mean annual change for all midface measurements compared to non-compliant subjects (SNA: -.57°, .56°; ANS-PNS: -.41mm, .95mm; SN-PP: -1.15°, .09°; A-SN': .40mm, 1.56mm; A-SN'perp: -.41mm, .8mm), and increased change in maxillary incisor measurements (U1-SN: 2.41°, -.51°; U1-PP: .10°, -.47°). Conclusions: Pressure to the midface from compliant PAP use during childhood may hinder normal facial growth, resulting in maxillary retrusion, counterclockwise tipping of the palatal plane, and flaring of the maxillary incisors.