IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rakotoson M1* * https://ijojournals.com/ Volume 08 || Issue 03 || March, 2025 || “ ORTHODONTIC TYPOLOGY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN MAHAJANGA, MADAGASCAR." ORTHODONTIC TYPOLOGY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN MAHAJANGA, MADAGASCAR Rakotoson M1,2*, Randrianandraina MP3,4, Ralaizafindraibe TH3,6,Raotoson H2,3, Rakotoarison KKA2, Randrianarimanarivo HM1 1Department of Orthodontics, Institute of Tropical Odonto-Stomatology of Madagascar (IOSTM) ; Madagascar 2Department of Maxillofacial Surgery, Hospital Professor ZAFISAONA Gabriel,Madagascar 3Faculty of MedicineMahajanga; Madagascar 4Department of Otorhinolaryngology (ENT), Hospital Professor ZAFISAONA Gabriel,Madagascar 5Department of ThoracicSurgery, Hospital Professor ZAFISAONA Gabriel, Madagascar Correspondingauthor : RAKOTOSON Mariette Department of Orthodontics, Institute of Tropical Odonto-Stomatology of Madagascar (IOSTM) ; Madagascar ABSTRACT Purpose:The aim of ourstudywas to describe the orthodontictypology of studentswith OSA in Mahajanga Madagascar. Material and methods:This is a cross-sectional descriptive study on a student population of the University of Mahajanga Madagascar on World Health Day in 2024 at the university campus. Sampling wasconducted in simple randomness. The data wasanalyzed on the SPPSS 25.0 software. Results:The surveyidentified 120 studentswith a sex ratio of 0.84. The averageagewas 22 years. The prevalence of OSA was 11.6%. The classification of the shift of the bony bases IJO JOURNALS Volume 08 | Issue 03 | March 2025 | https://ijojournals.com/index.php/hsn/index 9 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rakotoson M1* * https://ijojournals.com/ Volume 08 || Issue 03 || March, 2025 || “ ORTHODONTIC TYPOLOGY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN MAHAJANGA, MADAGASCAR." wasdominated by Class I at 50% of studentswhohad OSA. The exooralexamination of the profile in the sagittal direction evaluated a convex profile at 85.7%. Conclusion: OSA is a seriousunderdiagnosedpathology in Madagascar. The decliningintellectuallevel of studentscould have something to do withtheirhiddenhealth situation. Dentofacial Orthopedicsparticipates in the screening of thispathology in order to improve the health of the population in our country. Key words:Obstructive sleepapnea, Madagascar, Dentofacial orthopedics. 1. Introduction Obstructive sleepapnoea syndrome (OSA) isdefined by the occurrence of abnormallyfrequentepisodes of complete or partial obstruction of the upperairwayduringsleep, resulting in total interruption (apnea) or significantreductions (hypopnea) in ventilation [1]. Obstructive sleepapnea-hypopnea syndrome (OSAHS) isfeared, in addition to the cardiovascular complications it can induce or increase, for chronic fatigue, excessive daytimesleepiness, but also for the difficulties in concentration and attention to whichit exposes [2]. The literaturereview reports the prevalence of OSA in the general population in the order of 4 to 5% of men and 2% of women [3].Sleepdisorders are extremelycommon (40- 86%) in children and adolescents [4]. Obstructive SleepApnea Syndrome (OSA) can have an impact on attention and learningskills. The student population maybeconfrontedwiththispathologywhich can alter itsability to assimilate. The objective of ourstudywas to describe the orthodontictypology of studentswith OSA in Mahajanga Madagascar. 2. Materials and methods This is a cross-sectional descriptive study. The studyiscarried out on a student population of the University of Mahajanga Madagascar during the UniversityHealth Week dedicated to World Health Day in April 2024 at the university campus. Sampling wasconducted in simple IJO JOURNALS Volume 08 | Issue 03 | March 2025 | https://ijojournals.com/index.php/hsn/index 10 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rakotoson M1* * https://ijojournals.com/ Volume 08 || Issue 03 || March, 2025 || “ ORTHODONTIC TYPOLOGY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN MAHAJANGA, MADAGASCAR." randomness.The data collectedwereenteredinto an electronicsurveyformusing the Access® software version 2007. The data wasanalyzed on the SPPSS 25.0 software. Eachstudent's consent wasobtainedprior to their inclusion in the study and recalledprior to the start of the exam. The purpose of the study and all stages of the reviewwereexplainedorally. The confidentiality of information, humanrights, the rights to freedom of opinion, professionalsecrecy and privacy have been respected. 3. Results The surveyidentified 120 studentswith a sex ratio of 0.84. The averageagewas 22 years. Table 1 : Gender distribution Gender Number Percentage Male 55 45,8% Female 65 54,2% Total 120 100% Table 2 : Age distribution Age Numbre Percentage 18-23 yearsold 80 66,6% 24-30 yearsold 40 33,3% Total 120 100% Table 3 : Distribution by gender and presence of sleepapnea(n=120) Sleepapnea Gender Number Percentage Male 6 5% IJO JOURNALS Volume 08 | Issue 03 | March 2025 | https://ijojournals.com/index.php/hsn/index 11 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rakotoson M1* * https://ijojournals.com/ Volume 08 || Issue 03 || March, 2025 || “ ORTHODONTIC TYPOLOGY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN MAHAJANGA, MADAGASCAR." Female 8 6,6% Total 14 11,6% Table 4 : Distribution by dental class (n=120) Classe dentaire Gender Class I Class II Class III Male 25 (20,8%) 18 (15%) 12 (10%) Female 32 (26,6%) 23 (19,1%) 10 (8,3%) Total 57 (47,5%) 41 (34,1%) 22 (18,3%) Table 5 : Distribution by profile (n=120) Profile Gender Convex Concave Male 45 (37,5%) 10 (8,3%) Female 56 (46,6%) 9 (7,5%) Total 101 (84,1%) 19 (15,8%) 4. Discussion Our study reports a higher percentage of studentswithsleepapnea in the femalegender, while the literature states that the riskfactors for the development of sleepapneaare:obesity, male gender, age, black race, alcohol and tobacco and male genderisconsidered a predisposing factor. The frequency of OSA ishigher in men than in women [5]. The literatureindicatesthatsnoringincreaseswithage and thatitisexacerbated, amongotherthings, by alcohol, smoking, sedatives, sleepdeprivation [6]. A studycarried out in Kinshasa in 2008 IJO JOURNALS Volume 08 | Issue 03 | March 2025 | https://ijojournals.com/index.php/hsn/index 12 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rakotoson M1* * https://ijojournals.com/ Volume 08 || Issue 03 || March, 2025 || “ ORTHODONTIC TYPOLOGY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN MAHAJANGA, MADAGASCAR." reported a high percentage of subjectswith obstructive sleepapnea syndrome in groups of subjectsaged 25 to 35 years at 28.6% [7]. This differs in ourstudy, withstudentsaged 18 to 23 being more numerous at 66.6%. Nevertheless, Dayyat et al. proposedin 2007 a classification of OSA intothree types [8].Types 1 and 2 have in common the usualrespiratorysigns (snoring, restlesssleep, laboredbreathing, mouthbreathing, parent-describedbreathing stoppages, excessive sweating) and the possible existence of parasomnias (bedwetting, night terrors, and nightmares). In type 1, itismainlyyoung people who are not overweight, withmarkedadetonsillarhypertrophy and oftenwith attention deficithyperactivitydisorders, whereas in type 2 the children are overweightwithvisceral and truncalobesity, an increased neck diameter, and lessadenotonsillarhypertrophythan in type 1, But on the other hand, excessive daytimesleepiness and psychologicaldisorders (low self-esteem, depression, pathologicalshyness) are much more frequent, as well as cardiovascular and metabolic complications.Type 3 OSA occurs in subjectswithneurological, malformative or genetic pathologies, withcraniofacial malformations, neuromuscular or skeletalinvolvement (trisomy 21, Prader-Willi syndrome, Pierre-Robin syndrome, achondroplasia, craniostenosis) [9]. The prevalence of OSA wasestimated at 3.23% [10], but ourstudyreveals a prevalence of 11.6%. The standard treatmentismostoftenContinuous Positive Airway Pressure (CPAP), but also a Mandibular Advanced Orthosis, which have been reported by severalauthorsincludingRakotoson M et al in 2024 [11]. The MandibularAdvancementOrthosis can simultaneouslytreat a skeletal Class II, whichconstitutes 34.1% of ourstudy population.The convex profile makes up the majority of ourstudy population at 84.1%, whichcorroborates the study by Rakotoson M et al in 2023 [12,13]. 5. Conclusion OSA is a serious and underdiagnosed condition in Madagascar. The observation of excessive daytimesleepinessshouldbefearedbecause the decliningintellectuallevel of studentscould have IJO JOURNALS Volume 08 | Issue 03 | March 2025 | https://ijojournals.com/index.php/hsn/index 13 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rakotoson M1* * https://ijojournals.com/ Volume 08 || Issue 03 || March, 2025 || “ ORTHODONTIC TYPOLOGY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN MAHAJANGA, MADAGASCAR." a relationshipwiththeirhiddenhealth situation. Dentofacial Orthopedics or Orthodonticsparticipates in the screening of thispathology in order to improve the health of the population in our country. References 1.Kelly A, Evans. Screening Commercial Vehicle Drivers for ObstrctiveSleepApnea: Tools, Barriers, and Recommendations. OccupationalHealth and Safety. 2017. 2.Nowinski A, Plywaczewski R, Hawrylkiewicz, Sliwinski P, Gorecka D. ProBNPlevel for screening of cardiovascular complications in obstructive sleepapnea. Proc Am Thorac Soc. 2006;3. 3.Ba F, Sène M, El HddjiMBA, Fatou Bintou S, Arame M, Ousmane C. Obstructive sleepapneahypopnea syndrome in sub-SaharanAfrica:areview of the literature. SleepMedicine2020;17:169-76. 4.Schröder CM. Autismspectrumdisorders, sleep and biologicalrhythms. In:Sleep, rhythms and psychiatry. Eds CM Schröder & I Poirot, Dunod2016. 5.Escourrou P, Meslier N, Raffestin B. Whatis the clinicalapproach and diagnostic procedure for OSA?Rev Mal Res2010;27:115-23. 6.Arnulf I, Derenne JP. « Le SAS ». Medecine/sciences1999;15:807-14. 7.Ntima-Nsiemi AK, Mbuila CN, Kayembe JMB. Risk of road accidents among bus drivers in Kinshasa and signs suggestive of sleepapnea syndrome. HealthSci. 2021;22:83- 8. IJO JOURNALS Volume 08 | Issue 03 | March 2025 | https://ijojournals.com/index.php/hsn/index 14 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING ( ISSN: 2814-2098 ) Rakotoson M1* * https://ijojournals.com/ Volume 08 || Issue 03 || March, 2025 || “ ORTHODONTIC TYPOLOGY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN MAHAJANGA, MADAGASCAR." 8.Dayyat E, Kheirandish-Gozal L, Gozal D. Childhood obstructive sleepapnea: one or two distinct diseaseentities? Sleep Med Clin2007;2:433–44. 9.Dayyat E, Kheirandish-Gozal L, Gozal D. Childhood obstructive sleepapnea: one or two distinct diseaseentities? Sleep Med Clin2007;2:433–44. 10.Ntima-Nsiemi KA, Kayembe JM, MbuilaC;Prevalence of signs suggestive of obstructive sleepapnoeahypopnea syndrome in Kinshasa (DRC). Interest of management with the mandibularadvancementorthosis. Ann. Afr. Med. 2017;11:1. 11.Rakotoson M, Lalanirina GL, Rajaonarison LF, Ratsirarisoa T, Andriniaina FA, Andrinjakarivony NN, Rakotoharinivo HZ, et al. Efficacy of mandibularadvancementdevice in obstructive sleepapnea syndrome. IJP international journal of health sciences and nursing. 2024;7:33-41. 12.RakotosonM, Rabarijaona SG, RalaizafindraibeTH, Andriniaina FA, RatsirarisoaT, AndrinjakarivonyNN, RasoanirinaMO, et al. Obstructive SleepApnea Syndrome (OSAS) management in Dento-Facial Orthopedics. Magna Scientia Advanced Researchand Reviews2023;07:035–41. 13.Rakotoson M, Andriniaina FA, Ratsirarisoa T, Andrinjakarivony N, Rasoanirina MO, Andriambololo-Nivo RD, Randrianarimanarivo HM. Skeletalcephalometric profile of childrenaged 6 to 12 yearsaccording to steiner'sanalysis in mahajangamadagascar. Rosmel2020;19:30-6. IJO JOURNALS Volume 08 | Issue 03 | March 2025 | https://ijojournals.com/index.php/hsn/index 15