I read with interest the AAO white paper on OSA: Maybe some of the experts can chime in on their thoughts. Here is one passage:

XII. Fallacies About Orthodontics in Relation to OSA Conventional orthodontic treatment never has been proven to be an etiologic factor in the development of obstructive sleep apnea. When one considers the complex multifactorial nature of the disease, assigning cause to any one minor change in dentofacial morphology is not possible. However, misinformation exists regarding the potential airway related sequelae of orthodontic treatment performed with dental extractions or orthopedic headgear. The specific effects on the dental arches and the muscles and soft tissues of the oral cavity following orthodontic extractions can differ significantly, depending on the severity of dental crowding, the amount of protrusion of the anterior teeth and the specific mechanics used to close the extraction spaces. The indication for extractions varies from patient to patient, as does the resulting change to the width, length and arch perimeter of the dentition—all may increase, decrease, or stay the same following treatment. The impact that orthodontic treatment with or without dental extractions may have on the dimensions of the upper airway also has been examined directly, first with two‐dimensional cephalograms and more recently with three‐dimensional CBCT imaging.41 In certain instances, namely in patients with significant protrusion of both upper and lower anterior teeth where skeletal anchorage or extractions are used to retract the anterior teeth as much as possible to reduce lip protrusion in profile, reductions in the cross‐sectional area of the oropharynx have been reported. More frequently, as in patients where extractions are performed to help address dental crowding or improve the occlusion, there is no discernible change in airway dimensions when extractions are employed.42‐43 The studies examining these effects in children and adolescents have reported increases in airway volumes and crosssectional areas in patients both with and without extractions performed as part of their orthodontic treatment.44‐46 These effects may likely be related to normal growth changes. In discussing orthodontic treatment to changes in the dimensions of the upper airway, it also is helpful to understand that an initial small or subsequently reduced or increased size does not necessarily result in a change in airway function. Reflecting the higher significance of neuromuscular control on airway function during sleep, it has been demonstrated that a narrow airway does not result in OSA, but rather it is an inability for a patient’s airway muscles to compensate adequately that leads to obstruction and sleep‐disordered breathing.47 As such, future investigations should aim to place greater emphasis on the effects of airway function following orthodontic treatment, as opposed to focusing solely on quantifying airway dimensions. One such study assessed dental extractions as a cause of OSA later in life with a large retrospective examination of dental and medical records.48 Researchers reviewed the health records of more than 2700 adults with four missing premolars and evaluated whether
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this group had a higher prevalence of OSA compared to an equally sized group of patients with no missing teeth who also were matched for the most significant confounding variables of OSA in adults, namely age, BMI and gender. The study concluded that the prevalence of OSA was essentially the same in both groups, and that dental extractions were not a causative factor in OSA. Overall it can be stated that existing evidence in the literature does not support the notion that arch constriction or retraction of the anterior teeth facilitated by dental extractions, and which may (or may not) be the objective of orthodontic treatment, has a detrimental effect on respiratory function.