Can a novel intervention improve quality of life for children with sleep problems?

Testing the efficacy of a mandibular advancement splint in children who suffer from sleep-disordered breathing

Professor Mauro Farella
University of Otago, Dunedin

What is the problem and who does it affect?

Sleep-disordered breathing (SDB) varies from habitual snoring in moderate cases, to the more severe cases of complete obstruction of the airways. The New Zealand prevalence is surprisingly high, at about four per cent of children.

SDB can cause breathlessness and frequent waking during sleep due to the obstruction of the airways. Also, SDB can cause growth disorders, daytime sleepiness, educational concerns and behavioural problems. At its most severe, SDB can lead to life-threatening events like heart failure.

The litany of problems caused by SDB means it places a huge burden on families including the financial burden of treatment, as well as direct and indirect costs to the public health system.

 

What is the research hoping to achieve?

The most common treatment for SBD is an adenotonsillectomy, which consists of removing both the adenoids (lumps of tissue above the tonsils) and the tonsils. As a treatment, this is highly invasive, painful and expensive. It can take up to two weeks for children to recover.

 

What is this study hoping to achieve?

This study will test the efficacy and effectiveness of using a mandibular advancement splint (MAS) to treat SDB. The MAS acts by adjusting the position of the lower jaw, having the effect of tightening the soft tissue and muscles of the upper airway, preventing obstruction. They are also cheaper, more comfortable and less invasive. These splints have proven effective in adults, but as yet, there is little information as to their effectiveness in children.

The children enrolled in this research will be treated using both a true intervention and a dummy (placebo) intervention at different times. SDB improvement will be monitored using a portable breathing monitoring instrument, a microphone to record snoring sounds, questionnaires and blood samples. It is hoped that this data will inform wider implementation, leading to improved outcomes for children faced with sleep disordered breathing.