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Craniofacial morphology and sleep disordered breathing in children Aran, Reza


Objective: The aim of this study is to understand how craniofacial morphology and the severity of a malocclusion can contribute to sleep disordered breathing (SDB) symptoms in children when controlled for age, gender and body mass index (BMI). Methods: A total of 301 subjects with complete records were included in this study. Two hundred and thirty-seven were preadolescents, of which 97 were male and 140 were female (mean age 9.9±1.6); 64 were adolescents, of which 24 were male and 40 were female (mean age 13.8±0.9). All the subjects’ parents were asked to complete a SDB questionnaire. Lateral cephalometric images were analyzed to assess the position of the hyoid bone, length of the soft palate, and the maxillary and mandibular dental and skeletal relationship. A clinical examination was performed to determine the Angle classification, Mallampati score, tonsil size (Brodesky), and BMI. Results: Data from 301 children that completed the questionnaires and underwent a cephalometric analysis were evaluated. Subjects were divided into two groups based on their age and each group was further divided based on gender. By comparing preadolescents with adolescents we found that preadolescents presented a significantly higher incidence of hyperactivity, morning headaches, more frequent snoring, and bedwetting. Adolescents exhibited significantly higher daytime sleepiness, difficulty getting up, and impaired daytime function. When comparing female and male subjects, we found that frequent snoring, and morning headaches were more prevalent among females, while daytime sleepiness, and hyperactivity were more common among males. Craniofacial features that have a significant relationship with SDB symptoms are, a lower position of the hyoid bone, retruded mandible, steeper mandibular plane angle, and retroclined lower incisors. There was no statistically significant relationship between Angle classifications, tonsil size, Mallampati score, and BMI with SDB symptoms in this sample. Conclusion: This study suggests that craniofacial morphology, but not severity of malocclusions, could be a potential contributing factor to SDB symptom severity.  

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