Sleep‐disordered breathing and malocclusion in children and adolescents—a systematic review

Abstract

Sleep is essential and important for growth, development, learning and well-being in children and adolescents. Symptoms of sleep problems in schoolchildren can be bedtime resistance, difficulty initiating sleep because of anxiety, daytime sleepiness and nocturnal enuresis.Sleep problems can be caused by sleep-disordered breathing (SDB) such as obstructive sleep apnoea (OSA), insufficient sleep, delayed sleep-wake phase disorder and/or anxiety disorders. [1][2][3] The prevalence of OSA in children and adolescents is 1-5%-but may be underdiagnosed. [4][5][6] OSA is caused by central, sleep-induced neuromuscular hypotonia, in conjunction with decreased space in

Specific dento‐craniofacial characteristics in non‐syndromic children can predispose to sleep‐disordered breathing

“…In children, tonsillar hypertrophy and mouth breathing may be coexisting factors which increase the risk of SDB and are associated with anterior open bite. 2,16,[30][31][32][33] Anterior open bite is defined by visible space between the maxillary and mandibular incisors and is sometimes accompanied by anterior tongue pressure when the posterior teeth are in occlusal contact (Figure 1). Furthermore, extended head posture may be associated with anterior open bite in children.…”

“…18,23 Decreased palatal width is often accompanied by increased height in the vertical plane of the palate and accordingly may be associated with risk of impaired nasal upper airway volume (Figure 3). 16,20,[26][27][28]34 The decreased width of the palate may result in posterior cross bite due…”

“…Studies have shown that SDB in children may be correlated with anatomical characteristics of the upper airway, craniofacial morphology and dental occlusion. 2,[15][16][17][18][19][20] Studies have demonstrated associations between head posture and SDB, which may influence the development of the craniofacial skeleton and dental occlusion. 16,[21][22][23][24] Tonsillar hypertrophy is the primary cause of SDB in children, which may result in extended head posture and mouth breathing in an attempt to compensate for obstruction of the airway.…”

“…2,[15][16][17][18][19][20] Studies have demonstrated associations between head posture and SDB, which may influence the development of the craniofacial skeleton and dental occlusion. 16,[21][22][23][24] Tonsillar hypertrophy is the primary cause of SDB in children, which may result in extended head posture and mouth breathing in an attempt to compensate for obstruction of the airway. 21 A narrow upper airway has been reported to affect the development of the jaws and dental occlusion.…”

“…22,23 Some types of dento-craniofacial characteristics have been shown to increase the risk of upper airway obstructions, such as large overjet due to mandibular retrognathia. 1,[15][16][17]20,25 In addition, decreased palatal width may be a risk factor for SDB due to a smaller nasal upper airway volume. 15,[26][27][28] Another study found that decreased palatal width, snoring and restless sleep are more common in children with attention deficit hyperactivity disorder.…”