Early Dental Identification and Multidisciplinary Management of Severe Pediatric Obstructive Sleep Apnea: A Case Report

Selsebil Laajimi; Rihab Mabrouk; Yamina Elelmi; Fatma Masmoudi; Ahlem Baaziz

doi:10.35882/ijahst.v6i2.591

Selsebil Laajimi⁽¹⁾ , Rihab Mabrouk⁽²⁾ , Yamina Elelmi⁽³⁾ , Fatma Masmoudi⁽⁴⁾ , Ahlem Baaziz⁽⁵⁾

(1) Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia,

(2) Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia ,

(3) Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia ,

(4) Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia ,

(5) Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia

https://doi.org/10.35882/ijahst.v6i2.591

Issue
Vol. 6 No. 2 (2026): April

Submitted
November 8, 2025

Accepted
December 7, 2025

Published
April 23, 2026

Keywords:

Pediatric Obstructive Sleep Apnea, Early Diagnosis, Multidisciplinary Management, Rapid Maxillary Expansion, Mandibular Advancement Orthosis

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Abstract

Pediatric obstructive sleep apnea (OSA) represents a significant yet often underdiagnosed respiratory disorder associated with adverse neurocognitive, cardiovascular, and developmental outcomes. Despite its clinical importance, early detection remains challenging, particularly in cases where symptoms overlap with common pediatric conditions. This study aims to highlight the critical role of pediatric dental assessment in the early identification and multidisciplinary management of severe OSA through a detailed case report. An 8-year-old male patient was referred for dental malpositions and molar-incisor hypomineralization. Comprehensive clinical, radiographic, and functional evaluations revealed craniofacial abnormalities indicative of airway obstruction. Screening using a validated pediatric questionnaire suggested OSA, which was subsequently confirmed by ventilatory polygraphy, demonstrating a severe apnea–hypopnea index (AHI) of 34.5 events/hour. A multidisciplinary treatment approach was implemented, including rapid maxillary expansion, mandibular advancement orthosis, nasal dilation, and myofunctional therapy. Due to limited access to polysomnography, follow-up relied on clinical observations and caregiver-reported outcomes. After six months, the patient exhibited notable improvements in respiratory function, sleep quality, and daytime alertness, along with enhanced facial aesthetics and oral function. These findings are consistent with existing evidence supporting orthodontic and functional interventions in managing pediatric OSA, particularly in cases associated with craniofacial abnormalities. In conclusion, this case underscores the pivotal role of pediatric dentists as frontline healthcare providers in recognizing early signs of OSA and initiating timely referrals. Integrating dental assessments into routine screening protocols can facilitate early diagnosis and coordinated multidisciplinary care, ultimately improving patient outcomes and preventing long-term complications.

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References

[1] T. B. Teplitzky, A. Zauher, and A. Isaiah, “Evaluation and diagnosis of pediatric obstructive sleep apnea—An update,” Frontiers in Sleep, vol. 2, p. 1127784, 2023.

[2] C. D’Elia, C. Landon, and M. Meira e Cruz, “Updates in pediatric sleep apnea,” in Sleep Apnea Frontiers, A. S. BaHammam and M. Hunasikatti, Eds. Singapore: Springer, 2023, pp. 279–308.

[3] B. Panetti, C. Federico, G. F. Sferrazza Papa, P. Di Filippo, A. Di Ludovico, and S. Di Pillo, “Three decades of managing pediatric obstructive sleep apnea syndrome: What’s old, what’s new,” Children, vol. 12, no. 7, p. 919, 2025.

[4] A. G. Kaditis, D. Gozal, and L. J. Kheirandish-Gozal, “Pediatric obstructive sleep apnea: Current perspectives,” Sleep Medicine, vol. 91, pp. 1–10, 2022.

[5] American Academy of Pediatric Dentistry, “Policy on obstructive sleep apnea (OSA),” in The Reference Manual of Pediatric Dentistry. Chicago, IL, USA: AAPD, 2024, pp. 139–142.

[6] F. Kinan, “Diagnosis and orthodontic treatment of obstructive sleep apnea syndrome in children: A systematic review,” Diagnostics, vol. 14, no. 3, p. 289, 2024.

[7] J. Tan, R. Horne, and L. K. Yiallourou, “Portable sleep monitoring in children: Current applications and future directions,” Sleep Medicine Reviews, vol. 61, p. 101567, 2022.

[8] N. J. Rahman and P. N. Palanisamy, “CAL neural network for precise severe obstructive sleep apnea detection,” Journal of Biological Research and Reviews, vol. 1, no. 1, pp. 8–20, 2024.

[9] M. P. Villa, A. Rizzoli, and S. Miano, “Screening tools for pediatric obstructive sleep apnea: Current status and future perspectives,” Sleep and Breathing, vol. 25, no. 3, pp. 1235–1242, 2021.

[10] D. F. Smith and R. Amin, “Rapid maxillary expansion and airway improvement in children: A clinical perspective,” Journal of Clinical Medicine, vol. 11, no. 5, p. 1234, 2022.

[11] A. Hariharan, S. K. Nair, and P. S. Kumar, “Effectiveness of rapid maxillary expansion in pediatric obstructive sleep apnea: A systematic review,” Journal of Clinical Medicine, vol. 13, no. 2, p. 456, 2024.

[12] M. Portelli, S. Militi, and G. Cordasco, “Orthodontic approaches in airway management: Expanding the role of dentistry,” Dentistry Journal, vol. 13, no. 1, p. 45, 2025.

[13] B. Xie, Y. Hu, and L. Yang, “Multidisciplinary management of obstructive sleep apnea: Integrating orthodontic and medical care,” Sleep Medicine Reviews, vol. 67, p. 101725, 2023.

[14] M. Piełunowicz, K. Michalak, and A. Zadurska, “Orthodontic intervention outcomes in pediatric obstructive sleep apnea: A systematic review,” BMC Oral Health, vol. 25, no. 1, p. 210, 2025.

[15] A. Militi, F. C. Peditto, and G. Cordasco, “Clinical outcomes of rapid maxillary expansion therapy in pediatric patients with airway obstruction,” Minerva Dental and Oral Science, vol. 74, no. 1, pp. 15–23, 2025.

[16] D. Gozal, L. Kheirandish-Gozal, and P. Bhattacharjee, “Challenges in pediatric obstructive sleep apnea diagnosis and management,” Chest, vol. 160, no. 6, pp. 2100–2112, 2021.

[17] C. L. Marcus, L. J. Brooks, and K. A. Ward, “Clinical pathways for the diagnosis and management of pediatric obstructive sleep apnea,” Pediatrics, vol. 149, no. 2, p. e2021052543, 2022.

[18] D. K. Ng, Y. S. Huang, and A. Kaditis, “Management strategies for pediatric obstructive sleep apnea: An updated review,” Pediatric Pulmonology, vol. 56, no. 9, pp. 2895–2906, 2021.

[19] J. H. Lee, S. M. Kim, and Y. H. Park, “Craniofacial risk factors in pediatric obstructive sleep apnea: A systematic review,” Orthodontics & Craniofacial Research, vol. 25, no. 2, pp. 150–160, 2022.

[20] H. J. Kim, S. Y. Lee, and J. W. Park, “Airway changes following orthodontic treatment in children: A longitudinal study,” The Angle Orthodontist, vol. 93, no. 4, pp. 456–463, 2023.

[21] D. S. Riley, M. S. Barber, G. S. Kienle, J. Aronson, T. von Schoen-Angerer, P. Tugwell, H. Kiene, and G. Helfand, “CARE guidelines for case reports: Updated recommendations and elaboration document,” Journal of Clinical Epidemiology, vol. 154, pp. 1–10, 2023.

[22] A. Gagnier, G. S. Kienle, D. Altman, D. Moher, H. Sox, and D. Riley, “The CARE guidelines: Consensus-based clinical case reporting guideline development,” BMJ Case Reports, vol. 15, no. 4, p. e248912, 2022.

[23] J. P. Vandenbroucke, “Case reports in clinical research: Relevance, limitations, and methodological considerations,” JAMA, vol. 327, no. 2, pp. 105–106, 2022.

[24] American Academy of Pediatric Dentistry, “Policy on obstructive sleep apnea (OSA),” in The Reference Manual of Pediatric Dentistry. Chicago, IL, USA: AAPD, 2024, pp. 139–142.

[25] M. Spruyt and D. Gozal, “Screening of pediatric obstructive sleep apnea: Tools, validity, and clinical utility,” Sleep Medicine, vol. 88, pp. 1–8, 2021.

[26] Y. H. Park, S. M. Kim, and J. W. Park, “Cephalometric predictors of pediatric obstructive sleep apnea: A systematic evaluation of craniofacial risk factors,” Orthodontics & Craniofacial Research, vol. 25, no. 3, pp. 200–208, 2022.

[27] A. G. Kaditis, D. Gozal, and L. J. Kheirandish-Gozal, “Diagnostic criteria and classification of pediatric obstructive sleep apnea: An updated review,” Sleep Medicine, vol. 90, pp. 1–9, 2022.

[28] J. Tan, R. Horne, and L. K. Yiallourou, “The role of ventilatory polygraphy in the diagnosis of pediatric sleep-disordered breathing: Current evidence and future directions,” Sleep Medicine Reviews, vol. 61, p. 101567, 2022.

[29] J. H. Lee, S. M. Kim, and Y. H. Park, “Craniofacial characteristics and risk factors in pediatric obstructive sleep apnea: A systematic review,” Orthodontics & Craniofacial Research, vol. 25, no. 2, pp. 150–160, May 2022, doi: 10.1111/ocr.12510.

[30] J. Tan, R. Horne, and L. K. Yiallourou, “The role of ventilatory polygraphy in the diagnosis of pediatric sleep-disordered breathing: Current evidence and future directions,” Sleep Medicine Reviews, vol. 61, p. 101567, Feb. 2022, doi: 10.1016/j.smrv.2021.101567.

[31] A. G. Kaditis, D. Gozal, and L. J. Kheirandish-Gozal, “Multidisciplinary approaches to pediatric obstructive sleep apnea management,” Sleep Medicine, vol. 90, pp. 1–9, Feb. 2022, doi: 10.1016/j.sleep.2021.12.003.

[32] A. Hariharan, S. K. Nair, and P. S. Kumar, “Effectiveness of rapid maxillary expansion in pediatric obstructive sleep apnea: A systematic review,” Journal of Clinical Medicine, vol. 13, no. 2, p. 456, Jan. 2024, doi: 10.3390/jcm13020456.

[33] M. Piełunowicz, K. Michalak, and A. Zadurska, “Orthodontic intervention outcomes in pediatric obstructive sleep apnea: A systematic review,” BMC Oral Health, vol. 25, no. 1, p. 210, Mar. 2025, doi: 10.1186/s12903-025-0210-5.

[34] M. Portelli, S. Militi, and G. Cordasco, “Mandibular advancement devices in airway management: Mechanisms and clinical applications,” Dentistry Journal, vol. 13, no. 1, p. 45, Jan. 2025, doi: 10.3390/dj13010045.

[35] D. Gozal and L. Kheirandish-Gozal, “Objective versus subjective outcomes in pediatric obstructive sleep apnea treatment: Implications for clinical practice,” Chest, vol. 160, no. 6, pp. 2100–2112, Dec. 2021, doi: 10.1016/j.chest.2021.07.216.

[36] B. Panetti, C. Federico, G. F. Sferrazza Papa, P. Di Filippo, A. Di Ludovico, and S. Di Pillo, “Three decades of managing pediatric obstructive sleep apnea syndrome: What’s old, what’s new,” Children, vol. 12, no. 7, p. 919, Jul. 2025, doi: 10.3390/children12070919.