Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations


Chronic snoring is considered abnormal in a pediatric population. This disorder is often attributed to enlarged tonsils and adenoids, but multiple anatomic obstructions should also be considered. Facial and dental morphometry associations with various sleep-disordered breathing symptoms were investigated at an orthodontic clinic.


Parents or guardians were asked to complete a 4-part questionnaire on behalf of their children (n = 604; <18 years of age), including medical and dental history, bruxism and temporomandibular disorder habits, sleep and daytime behavior, and sleep duration and quality. All subjects underwent a clinical screening assessment by the same orthodontist to identify standard dental, skeletal, functional, and esthetic factors.


In contrast to sleep-disordered breathing or sleep apnea in adults, which is predominantly associated with obesity, sleep-disordered breathing symptoms in this pediatric cohort were primarily associated with adenotonsillar hypertrophy, morphologic features related to a long and narrow face (dolichofacial, high mandibular plane angle, narrow palate, and severe crowding in the maxilla and the mandible), allergies, frequent colds, and habitual mouth breathing.


Because of the recognized impact of pediatric snoring on children’s health, the determination of these good predictors can help in preventing and managing sleep-disordered breathing. If a health professional notices signs and symptoms of sleep-disordered breathing, the young patient should be referred to a sleep medicine specialist in conjunction with an orthodontist if there are dentoskeletal abnormalities.

Sleep-disordered breathing forms a severity continuum from primary snoring to obstructive sleep apnea—ie, cessation of breathing. Chronic snoring, albeit common in adulthood, is considered abnormal in a pediatric population. Among children and adolescents, the prevalence of primary snoring has been reported at 3.2% to 12.1%, and the prevalence for obstructive sleep apnea is estimated at 0.7% to 10.3%. Sleep-disordered breathing in children has been associated with a wide variety of symptoms ( Table I ). Patients often report associated excessive daytime fatigue, morning headaches, loud and abnormal snoring or breathing, restless sleep, impaired intellectual function and attention, mood disturbance, aggressive behavior, and hyperactivity. Sleep-disordered breathing is often underdiagnosed in children and teenagers because the primary complaints reported by parents are more often behavioral symptoms.

Table I
Symptoms of sleep-disordered breathing in children and adolescents
Nighttime Daytime
• Abnormal sleeping positions • Morning tension-type headache
• Chronic, heavy snoring • Mouth breathing
• Confused arousal • Excessive morning thirst
• Delayed sleep onset • Excessive fatigue and sleepiness
• Difficulty breathing during sleep • Abnormal shyness, withdrawn and depressive presentation
• Difficulty waking up in the morning • Behavioral problems
• Drooling • Pattern of attention-deficit/ hyperactivity disorder (ADHD)
• Enuresis • Aggressiveness
• Frequent awakenings • Irritability
• Insomnia • Poor concentration
• Mouth breathing • Learning difficulties
• Nocturnal migraine • Memory impairment
• Nocturnal sweating • Poor academic performance
• Periodic limb movement
• Restless sleep
• Sleep talking
• Sleep terror
• Sleepwalking
• Witnessed breathing pauses during sleep
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Apr 10, 2017 | Posted by in Orthodontics | Comments Off on Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations

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