**7. Conclusion**

**5.3. Adjunctive treatment**

384 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

*5.3.1. Pharmacological therapy*

further research. [64]

*5.3.2. Bariatric surgery*

loss. [44, 65]

of this condition.

absence of other evident causes for their sleepiness. [44, 63]

A wide range of medication targeting OSA treatment has been explored in the literature. Except for hypothyroidism or acromegaly in which medication can improve AHI, there are no really effective pharmacotherapies for OSA. Topical nasal corticosteroids can be used in patients with OSA and concomitant rhinitis especially in children, and thus may be a useful adjunct to primary therapies for OSA. In addition, Modafinil, a psychostimulant, is recommended for the treatment of residual excessive daytime sleepiness despite effective PAP treatment and

A Cochrane review issued in 2013 showed insufficient evidence to recommend any systemic pharmacological treatment for OSA; drug therapy needs to be targeted depending on the presence or absence of obesity and the predominance of OSA in a particular sleep stage. The review also reported that among all drugs evaluated, Donepezil is the most promising for

Bariatric surgery consists of a variety of operative techniques performed to promote weight reduction such reducing gastric banding, gastric and jujenoileal bypass or gastroplasty. It is often recommended for treatment of morbid obesity, particularly when associated with other medical complications (BMI ≥ 35 kg/m2) or those with a BMI ≥ 35 kg/m2 when dietary efforts fail at weight control. Therefore women seem likely to be candidates for this method of weight

As cited above, OSA is associated with numerous craniofacial abnormalities. Orthodontics improvement of dento-facial morphology may have a positive impact on OSA components. Orthodontic professionals should provide treatment for OSA patients as well as diagnose potential OSA patients. Medical history and clinical examination allows orthodontists to identify the risk factors of OSA or signs related to OSA (obesity, allergy, nasal dysfunction, maxillary constriction, retrognathia, long uvula, mouth breathing...) or record some symptoms reported by patients. Moreover, several imaging modalities (lateral and frontal cephalogram, cone beam computed tomography, MRI.) can assist Orthodontic professionals in assessment

Orthodontic management of OSA syndrome could be provided to children as a preventive and interceptive modal or to adults by an interdisciplinary management. A significant number of children suffering from respiratory problems and obstructive sleep apnea have nasal obstruction associated with a narrow maxilla that may increase nasal resistance and alter the tongue posture, leading to a narrowing of the retroglossal airway and OSA. Maxillary

**6. Obstructive sleep apnea syndrome in orthodontic practice**

OSA is a common breathing disorder, which affects all age groups. It is a serious public health problem. Because of its potential pathophysiological consequences, it associates alteration of quality of life, decreased economic potential and increased morbidity and mortality in affected patients. Assessment of OSA requires a thorough clinical examination as well as overnight testing to determine PSA presence and severity before initiating treatment. Polysomnography remains the most common and reliable test for OSA diagnosis. Additionally, several imaging modalities can be used for upper airway structure and function during wakefulness and sleep. Treatment modalities of OSA are aimed at increasing life expectancy, decreasing disease problems and improving the quality of life. CPAP is still the mainstay for treatment of moderate to severe OSA. However, medical or surgical alternatives can be used in case of failure or non-compliance of the patients.

OSA is also a condition that orthodontists may encounter in their daily practice; thus, they are in a better position to diagnose and treat it using a multidisciplinary approach and management.
