Long-Term Changes Following Orthopedic Mandibular Advancement Therapy in Pediatric Obstructive Sleep Apnea: a 7-Year Follow-up Study.

STUDY

OBJECTIVES

To evaluate long-term changes in craniofacial morphology, upper airway dimensions, and sleep-related parameters following monoblock mandibular advancement therapy in children with obstructive sleep apnea (OSA).

METHODS

This longitudinal follow-up study included 13 children (mean age 10.97 ± 1.51 years) with OSA and mandibular retrognathia treated with a monoblock appliance. The mean duration of active treatment was 8.06 ± 1.29 months. Assessments were conducted at baseline (T1), post-treatment (T2), and 7 years after treatment (T3), including lateral cephalometric radiographs, polysomnography (PSG), and Pittsburgh Sleep Quality Index (PSQI) scores. Pharyngeal airway changes were analyzed using a standardized cephalometric protocol across 11 sagittal reference planes. Repeated measures ANOVA and nonparametric equivalents were applied for longitudinal comparisons.

RESULTS

Increases in oropharyngeal and hypopharyngeal airway dimensions (S6-S10; referring to standardized sagittal measurement planes) observed after treatment were generally maintained over time. Skeletal parameters showed relative stability at follow-up. Although Apnea-Hypopnea Index (AHI) decreased significantly after treatment, an increase was noted at T3. The percentage of REM (Rapid Eye Movement) sleep showed no significant change between T1 and T2, whereas a statistically significant increase was observed at T3. PSQI scores improved initially and did not show significant long-term deterioration.

CONCLUSIONS

This study provides long-term follow-up data on craniofacial, airway, and sleep-related changes in children with OSA treated with a monoblock appliance. Although partial recurrence of AHI was observed during adolescence, airway dimensions and skeletal parameters demonstrated relative stability over time. These findings suggest that structural adaptations may be maintained, while functional outcomes may vary during growth. Given the multifactorial nature of pediatric OSA, these results should be interpreted cautiously and warrant further investigation in larger longitudinal studies.