Avaliação das características dentoesqueléticas e os efeitos da adenotonsilectomia e expansão rápida da maxila no IAH, volume das vias aéreas superiores, dinâmica computacional de fluidos e área de secção transversal mínima em crianças com constricção de maxila e apneia obstrutiva do sono: Um estudo clínico randomizado crossover

Abstract

OSA is characterized by recurrent episodes of partial or total obstruction of the upper airways (UA) that induce intermittent hypoxemia, micro-arousals and sleep fragmentation. The prevalence of pediatric OSA is 4%, and the gold standard for diagnosis is nocturnal polysomnography. The general objective of this thesis was to evaluate the dentoskeletal characteristics and the effects of adentonsillectomy and rapid maxillary expansion on AHI, upper airway volume, computational fluid dynamics and minimum cross-sectional area in children with maxillary constriction and obstructive sleep apnea. Specific objective 1. The effect of adenotonsillectomy and rapid maxillary expansion on the upper airway in pediatric obstructive sleep apnea: a crossover randomized controlled trial. Specific 2. The effects of adenotonsillectomy and rapid maxillary expansion on volume, minimum area, and fluid dynamics in face-balanced pediatric obstructive sleep apnea: a randomized controlled crossover trial. Specific objective 3. Comparative analysis of the craniofacial characteristics of apneic children with and without maxillary constriction. From the results found in this thesis, we can conclude that the effects generated by adenotonsillectomy in improving AHI were greater, and ERM had a marginal effect on pediatric obstructive sleep apnea. The upper airways of children diagnosed with OSA have a greater tendency to collapse due to hypertrophy of lymphoid tissues. When initially performed, our results demonstrated that the effects of AT on volumetric gain in the upper airways were greater when compared to ERM. The effects of ERM on volumetric gain were not significant. A partial impact of the volumetric increase on fluid dynamics was observed, due to the anatomical complexity of the VAS. In our third study, it was not possible to verify the existence of dentoskeletal changes that explain the presence and absence of maxillary constriction in children with obstructive sleep apnea.