Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
권호 표지
DOI QR코드

DOI QR Code

Relationship between Upper Airway and Sleep-Disordered Breathing in Children with Mouth Breathing

구호흡 어린이에서 수면호흡장애와 상기도와의 관계

  • Kim, Doyoung (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Chonbuk National University) ;
  • Lee, Daewoo (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Chonbuk National University) ;
  • Kim, Jaegon (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Chonbuk National University) ;
  • Yang, Yeonmi (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Chonbuk National University)
  • 김도영 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소) ;
  • 이대우 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소) ;
  • 김재곤 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소) ;
  • 양연미 (전북대학교 치의학전문대학원 소아치과학교실 및 구강생체과학연구소)
  • Received : 2018.06.26
  • Accepted : 2018.07.26
  • Published : 2019.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

The most common cause of mouth breathing is obstacles caused by mechanical factors in upper airway. Mouth breathing could be consequently pathological cause of sleep-disordered breathing. Sleep-disordered breathing in children can cause growth disorders and behavioral disorders. The purpose of this study was to investigate relationship between upper airway and sleep-disordered breathing in children with mouth breathing. Twenty boys between 7 - 9 years old who reported to have mouth breathing in questionnaire were evaluated with clinical examination, questionnaires, lateral cephalometric radiographs, and portable sleep testing. This study assessed apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) for the evaluation of sleep-disordered breathing and was done to investigate the correlation between these values and the upper airway width measured by lateral cephalometric radiographs. There was no significant correlation with the size of the tonsils (p = 0.921), but the adenoid hypertrophy was higher in the abnormal group than in the normal group (p = 0.008). In the classification according to AHI and ODI, retropalatal and retroglossal distance showed a statistically significant decrease in the abnormal group compared to the normal group (p = 0.002, p = 0.001). As AHI and ODI increased, upper airway width tended to be narrower. This indicates that mouth breathing could affect the upper airway, which is related to sleep quality.

구호흡을 야기하는 가장 흔한 원인은 상기도의 폐쇄이다. 구호흡은 수면호흡장애의 병인론적 원인이 될 수 있으며, 어린이에서 수면호흡장애는 성장장애와 행동학적 문제를 일으킬 수 있다. 이 연구의 목적은 구호흡 어린이에서 수면호흡장애와 상기도와의 관계를 조사하고자 함에 있다. 초진 설문지에서 구호흡이 있다고 응답한 7 - 9세의 20명 남자 어린이를 대상으로 하였다. 편도평가, 구호흡 및 수면호흡장애와 관련된 설문지, 측모두부 방사선사진, 그리고 휴대용 간이수면검사를 시행하였다. 수면호흡장애에 대한 평가로 무호흡-저호흡 지수(apnea-hypopnea index, AHI), 산소불포화 지수(oxygen desaturation index, ODI)와 측모두부 방사선 사진을 통해 측정한 상기도 폭경과의 관계를 평가하였다. 상기도 부위 중 후구개 거리와 후설 거리는 무호흡-저호흡 지수와 산소불포화 지수가 커질수록 좁아지는 경향을 보였다(p = 0.002, p = 0.001). 또한, 편도의 크기와는 유의한 상관관계는 없었지만, 아데노이드 비대율의 경우 무호흡-저호흡 지수가 비정상군이 정상군에 비해 아데노이드가 비대하였다(p = 0.008). 이 연구결과를 통해 구호흡이 상기도에 영향을 미칠 수 있고 이는 수면호흡장애까지 연관될 수 있음을 확인할 수 있었다.

Keywords

References

  1. Marcus CL : Sleep-disordered breathing in children. Am J Respir Crit Care Med, 164:16-30, 2001. https://doi.org/10.1164/ajrccm.164.1.2008171
  2. American Thoracic Society : Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med, 153:866-878, 1996. https://doi.org/10.1164/ajrccm.153.2.8564147
  3. Berry RB, Gamaldo CE, Marcus CL, et al. : AASM scoring manual version 2.2 updates: new chapters for scoring infant sleep staging and home sleep apnea testing. J Clin Sleep Med, 11:1253-1254, 2015. https://doi.org/10.5664/jcsm.5176
  4. Marcus CL, McColley SA, Schwartz AR, et al. : Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Physiol, 77:918-924, 1994. https://doi.org/10.1152/jappl.1994.77.2.918
  5. Marcus CL, Brooks LJ, Spruyt K, et al. : Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 130:714-755, 2012. https://doi.org/10.1542/peds.2012-1672
  6. Laurikainen E, Aitasalo K, Erkinjuntti M, Wanne O : Sleep apnea syndrome in children - secondary to adenotonsillar hypertrophy?. Acta Otolaryngol Suppl, 492:38-41, 1992.
  7. Lee CH, Kang KT, Hsu WC, et al. : Quality of life after adenotonsillectomy for children with sleep disordered breathing: a linear mixed model analysis. Int J Pediatr Otorhinolaryngol, 78:1374-1380, 2014. https://doi.org/10.1016/j.ijporl.2014.05.038
  8. Jefferson Y : Mouth breathing: adverse effects on facial growth, health, academics, and behavior. Gen Dent, 58:18-25, 2010.
  9. Keating J, Park JH : Evaluation of current screening and treatment patterns for pediatric obstructive sleep apnea among practicing pediatric dentists in the united states: a pilot study. Pediatr Dent, 38:393-397, 2016.
  10. Korean Academy of Pediatric Dentistry : Textbook of Pediatric Dentistry, 5th ed. Yenang, Seoul, 217-270, 2014.
  11. Valera FC, Travitzki LV, Anselmo-Lima WT, et al. : Muscular, functional and orthodontic changes in preschool children with enlarged adenoids and tonsils. Int J Pediatr Otorhinolaryngol, 67:761-770, 2003. https://doi.org/10.1016/S0165-5876(03)00095-8
  12. Fernbach SK, Brouillette RT, Riggs TW, Hunt CE : Radiologic evaluation of adenoids and tonsils in children with obstructive sleep apnea: plain films and fluoroscopy. Pediatr Radiol, 13:258-265, 1983. https://doi.org/10.1007/BF00973342
  13. Matter SE, Anselmo-Lima WT, Valera FC, Matsumoto MA : Skeletal and occlusal characteristics in mouth-breathing pre-school children. J Clin Pediatr Dent, 28:315-318, 2004. https://doi.org/10.17796/jcpd.28.4.hg0k800564031787
  14. Chung Leng Munoz I, Beltri Orta P : Comparison of cephalometric patterns in mouth breathing and nose breathing children. Int J Pediatr Otorhinolaryngol, 78:1167-1172, 2014. https://doi.org/10.1016/j.ijporl.2014.04.046
  15. Pacheco MC, Casagrande CF, de Araujo MT, et al. : Guidelines proposal for clinical recognition of mouth breathing children. Dental Press J Orthod, 20:39-44, 2015. https://doi.org/10.1590/2176-9451.20.4.039-044.oar
  16. Fujioka M, Young LW, Girdany BR : Radiographic evaluation of adnoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol, 133:401-404, 1979. https://doi.org/10.2214/ajr.133.3.401
  17. Katz ES, D'Ambrosio CM : Pathophysiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc, 5:253-262, 2008. https://doi.org/10.1513/pats.200707-111MG
  18. Cheon M, Yang S, Choi N, et al. : Pharyngeal airway dimensions in skeletal class II young adolescents: cephalometric study. J Korean Acad Pediatr Dent, 45:98-108, 2018.
  19. Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D : Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc, 5:274-282, 2008. https://doi.org/10.1513/pats.200708-138MG
  20. Guilleminault C, Lee JH, Chan A : Pediatric obstructive sleep apnea syndrome. Arch Pediatr Adolesc Med, 159:775-785, 2005. https://doi.org/10.1001/archpedi.159.8.775
  21. O'Brien LM, Mervis CB, Gozal D, et al. : Neurobehavioral implications of habitual snoring in children. Pediatrics, 114:44-49, 2004. https://doi.org/10.1542/peds.114.1.44
  22. Suratt PM, Barth JT, Rembold C, et al. : Reduced time in bed and obstructive sleep-disordered breathing in children are associated with cognitive impairment. Pediatrics, 119:320-329, 2007. https://doi.org/10.1542/peds.2006-1969
  23. Chervin RD, Ruzicka DL, Guire KE, et al. : Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics, 117:769-778, 2006. https://doi.org/10.1542/peds.2005-1837
  24. Suratt PM, Peruggia M, Johnson ML, et al. : Cognitive function and behavior of children with adenotonsillar hypertrophy suspected of having obstructive sleep-disordered breathing. Pediatrics, 118:771-781, 2006. https://doi.org/10.1542/peds.2006-0173
  25. Tauman R, Ivanenko A, O'Brien LM, Gozal D : Plasma C-reactive protein levels among children with sleep-disordered breathing. Pediatrics, 113:564-569, 2004. https://doi.org/10.1542/peds.113.6.e564
  26. Akcay A, Kara CO, Dagdeviren E, Zencir M : Variation in tonsil size in 4- to 17-year-old schoolchildren. J Otolaryngol, 35:270-274, 2006. https://doi.org/10.2310/7070.2005.0118
  27. Jee HM : Upper airway and obstructive sleep apnea in children. Allergy Asthma Respir Dis, 5:3-7, 2017. https://doi.org/10.4168/aard.2017.5.1.3
  28. Smith DL, Gozal D, Hunter SJ, Kheirandish-Gozal L : Frequency of snoring, rather than apnea-hypopnea index, predicts both cognitive and behavioral problems in young children. Sleep Med, 34:170-178, 2017. https://doi.org/10.1016/j.sleep.2017.02.028
  29. Lee SH, Choi JH, Lee SH, et al. : How does open-mouth breathing influence upper airway anatomy?. Laryngoscope, 117:1102-1106, 2007. https://doi.org/10.1097/MLG.0b013e318042aef7
  30. Arens R, McDonough JM, Udupa JK, et al. : Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 167:65-70, 2003. https://doi.org/10.1164/rccm.200206-613OC
  31. Collop NA, Anderson WM, Schwab R, et al. : Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable monitoring task force of the American Academy of Sleep Medicine. J Clin Sleep Med, 3:737-747, 2007. https://doi.org/10.5664/jcsm.27032
  32. Tan HL, Gozal D, Kheirandish-Gozal L, et al. : Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea. Sleep, 37:255-260, 2014. https://doi.org/10.5665/sleep.3392
  33. Zucconi M, Calori G, Castronovo V, Ferini-Strambi L : Respiratory monitoring by means of an unattended device in children with suspected uncomplicated obstructive sleep apnea: a validation study. Chest, 124:602-607, 2003. https://doi.org/10.1378/chest.124.2.602
  34. Ghegan MD, Angelos PC, Stonebraker AC, Gillespie MB : Laboratory versus portable sleep studies: a meta-analysis. Laryngoscope, 116:859-864, 2006. https://doi.org/10.1097/01.mlg.0000214866.32050.2e
  35. Franco P, Bourdin H, Challamel MJ, et al. : Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea. Arch Pediatr, 24 Suppl 1:16-27, 2017. https://doi.org/10.1016/j.arcped.2016.09.050