Article Data

  • Views 4052
  • Dowloads 612

Original Research

Open Access

Orofacial dysfunction screening examinations in children with sleep-disordered breathing symptoms

  • Dao Anh Hoang1,3
  • Van Nhat Thang Le1
  • Tam Minh Nguyen2
  • Triin Jagomägi3,*,

1Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, Hue University, 49120 Hue, Vietnam

2Department of Family Medicine, Hue University of Medicine and Pharmacy, Hue University, 49120 Hue, Vietnam

3Institute of Dentistry, Faculty of Medicine, University of Tartu, 50090 Tartu, Estonia

DOI: 10.22514/jocpd.2023.032 Vol.47,Issue 4,July 2023 pp.25-34

Submitted: 22 November 2022 Accepted: 23 February 2023

Published: 03 July 2023

*Corresponding Author(s): Triin Jagomägi E-mail: triin.jagomagi@ut.ee

Abstract

Orofacial myofunctional disorders (OMD) and sleep-disordered breathing (SDB) may present as comorbidities. Orofacial characteristics might serve as a clinical marker of SDB, allowing early identification and management of OMD and improving treatment outcomes for sleep disorders. The study aims to characterize OMD in children with SDB symptoms and to investigate possible relationships between the presence of various components of OMD and symptoms of SDB. A cross-sectional study of healthy children aged 6–8 from primary schools was conducted in central Vietnam in 2019. SDB symptoms were collected using the parental Pediatric Sleep Questionnaire, Snoring Severity Scale, Epworth Daytime Sleepiness Scale, and lip-taping nasal breathing assessment. Orofacial myofunctional evaluation included assessment of tongue mobility, as well as of lip and tongue strength using the Iowa Oral Performance Instrument, and of orofacial characteristics by the protocol of Orofacial Myofunctional Evaluation with Scores. Statistical analysis was used to investigate the relationship between OMD components and SDB symptoms. 487 healthy children were evaluated, of whom 46.2% were female. There were 7.6% of children at high risk of SDB. Children with habitual snoring (10.3%) had an increased incidence of restricted tongue mobility and decreased lip and tongue strength. Abnormal breathing patterns (22.4%) demonstrated lower posterior tongue mobility and lower muscle strength. Daytime sleepiness symptoms were associated with changes in muscle strength, facial appearance, and impaired orofacial function. Lower strengths of lip and tongue or improper nasal breathing were more likely to be present in children with reported sleep apnea (6.6%). Neurobehavioral symptoms of inattention and hyperactivity were linked to anomalous appearance/posture, increases in tongue mobility and oral strength. This study demonstrates a prevalence of orofacial myofunctional anomalies in children exhibiting SDB symptoms. Children with prominent SDB symptoms should be considered as candidates for further orofacial myofunctional assessment.


Keywords

Orofacial dysfunction; Sleep-disordered breathing; Screening examination


Cite and Share

Dao Anh Hoang,Van Nhat Thang Le,Tam Minh Nguyen,Triin Jagomägi. Orofacial dysfunction screening examinations in children with sleep-disordered breathing symptoms. Journal of Clinical Pediatric Dentistry. 2023. 47(4);25-34.

References

[1] Burman D. Sleep disorders: sleep-related breathing disorders. FP Essentials. 2017; 460: 11–21.

[2] Beebe DW. Neural and neurobehavioral dysfunction in children with obstructive sleep apnea. PLOS Medicine. 2006; 3: e323.

[3] Chervin RD, Archbold KH, Dillon JE, Panahi P, Pituch KJ, Dahl RE, et al. Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics. 2002; 109: 449–456.

[4] Cistulli PA. Craniofacial abnormalities in obstructive sleep apnoea: implications for treatment. Respirology. 1996; 1: 167–174.

[5] Crabtree VM, Varni JW, Gozal D. Health-related quality of life and depressive symptoms in children with suspected sleep-disordered breathing. Sleep. 2004; 27: 1131–1138.

[6] Goldstein NA, Pugazhendhi V, Rao SM, Weedon J, Campbell TF, Goldman AC, et al. Clinical assessment of pediatric obstructive sleep apnea. Pediatrics. 2004; 114: 33–43.

[7] Guilleminault C, Lee JH, Chan A. Pediatric obstructive sleep apnea syndrome. Archives of Pediatrics & Adolescent Medicine. 2005; 159: 775.

[8] Halbower AC, Degaonkar M, Barker PB, Earley CJ, Marcus CL, Smith PL, et al. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLOS Medicine. 2006; 3: e301.

[9] Shin C, Joo S, Kim J, Kim T. Prevalence and correlates of habitual snoring in high school students. Chest. 2003; 124: 1709–1715.

[10] Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. European Respiratory Journal. 2016; 47: 69–94.

[11] Beck SE, Marcus CL. Pediatric polysomnography. Sleep Medicine Clinics. 2009; 4: 393–406.

[12] Bixler EO, Vgontzas AN, Lin HM, Liao D, Calhoun S, Vela-Bueno A, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009; 32: 731–6.

[13] Li AM, So HK, Au CT, Ho C, Lau J, Ng SK, et al. Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study. Thorax. 2010; 65: 991–997.

[14] Harvold EP, Tomer BS, Vargervik K, Chierici G. Primate experiments on oral respiration. American Journal of Orthodontics. 1981; 79: 359–372.

[15] Friedman M, Soans R, Gurpinar B, Lin HC, Joseph NJ. Interexaminer agreement of Friedman tongue positions for staging of obstructive sleep apnea/hypopnea syndrome. Otolaryngology-Head and Neck Surgery. 2008; 139: 372–7.

[16] D’Onofrio L. Oral dysfunction as a cause of malocclusion. Orthodontics & Craniofacial Research. 2019; 22: 43–48.

[17] Felício CMD, Ferreira CLP. Protocol of orofacial myofunctional evaluation with scores. International Journal of Pediatric Otorhinolaryngology. 2008; 72: 367–375.

[18] Folha GA, Valera FCP, de Felício CM. Validity and reliability of a protocol of orofacial myofunctional evaluation for patients with obstructive sleep apnea. European Journal of Oral Sciences. 2015; 123: 165–172.

[19] Baidas L, Al-Jobair A, Al-Kawari H, AlShehri A, Al-Madani S, Al-Balbeesi H. Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children. BMC Oral Health. 2019; 19: 43.

[20] de Felício CM, da Silva Dias FV, Folha GA, de Almeida LA, de Souza JF, Anselmo-Lima WT, et al. Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy. International Journal of Pediatric Otorhinolaryngology. 2016; 90: 5–11.

[21] Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Medicine. 2000; 1: 21–32.

[22] Chervin RD, Weatherly RA, Garetz SL, Ruzicka DL, Giordani BJ, Hodges EK, et al. Pediatric sleep questionnaire. Archives of Otolaryngology-Head and Neck Surgery. 2007; 133: 216.

[23] Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14: 540–545.

[24] Lim PV, Curry AR. A new method for evaluating and reporting the severity of snoring. The Journal of Laryngology & Otology. 1999; 113: 336–40.

[25] Morris LGT, Kleinberger A, Lee KC, Liberatore LA, Burschtin O. Rapid risk stratification for obstructive sleep apnea, based on snoring severity and body mass index. Otolaryngology-Head and Neck Surgery. 2008; 139: 615–618.

[26] Friedman M, Hamilton C, Samuelson CG, Lundgren ME, Pott T. Diagnostic value of the friedman tongue position and mallampati classification for obstructive sleep apnea: a meta-analysis. Otolaryngology-Head and Neck Surgery. 2013; 148: 540–547.

[27] Zaghi S, Peterson C, Shamtoob S, Fung B, Kwok-keung Ng D, Jagomagi T, et al. Assessment of nasal breathing using lip taping: a simple and effective screening tool. International Journal of Ophthalmology. 2020; 6: 10.

[28] Brodsky L. Modern assessment of tonsils and adenoids. Pediatric Clinics of North America. 1989; 36: 1551–1569.

[29] Friedman M, Hamilton CS, Samuelson CG. Friedman and Mallampati Tongue Positions and Obstructive Sleep Apnea Severity. Otolaryngology-Head and Neck Surgery. 2012; 147: 121.

[30] Yoon A, Zaghi S, Weitzman R, Ha S, Law CS, Guilleminault C, et al. Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects. Sleep and Breathing. 2017; 21: 767–775.

[31] Zaghi S, Shamtoob S, Peterson C, Christianson L, Valcu-Pinkerton S, Peeran Z, et al. Assessment of posterior tongue mobility using lingual-palatal suction: progress towards a functional definition of ankyloglossia. Journal of Oral Rehabilitation. 2021; 48: 692–700.

[32] Jang S, Cha B, Ngan P, Choi D, Lee S, Jang I. Relationship between the lingual frenulum and craniofacial morphology in adults. American Journal of Orthodontics and Dentofacial Orthopedics. 2011; 139: e361–e367.

[33] Potter NL, Short R. Maximal tongue strength in typically developing children and adolescents. Dysphagia. 2009; 24: 391–397.

[34] Kim H. Statistical notes for clinical researchers: evaluation of measurement error 2: Dahlberg’s error, Bland-Altman method, and Kappa coefficient. Restorative Dentistry & Endodontics. 2013; 38: 182.

[35] Bandyopadhyay A, Kaneshiro K, Camacho M. Effect of myofunctional therapy on children with obstructive sleep apnea: a meta-analysis. Sleep Medicine. 2020; 75: 210–217.

[36] Zhang F, Tian Z, Shu Y, Zou B, Yao H, Li S, et al. Efficiency of orofacial myofunctional therapy in treating obstructive sleep apnoea: a meta-analysis of observational studies. Journal of Oral Rehabilitation. 2022; 49: 734–745.

[37] Guilleminault C, Huang Y. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Medicine Reviews. 2018; 40: 203–214.

[38] Zancanella E, Haddad FM, Oliveira LA, Nakasato A, Duarte BB, Soares CF, et al. Obstructive sleep apnea and primary snoring: treatment. Brazilian Journal of Otorhinolaryngology. 2014; 80: S17–28.

[39] Guilleminault C, Huseni S, Lo L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Research. 2016; 2: 00043–02016.

[40] Villa MP, Evangelisti M, Barreto M, Cecili M, Kaditis A. Short lingual frenulum as a risk factor for sleep-disordered breathing in school-age children. Sleep Medicine. 2020; 66: 119–122.

[41] Ruffoli R, Giambelluca MA, Scavuzzo MC, Bonfigli D, Cristofani R, Gabriele M, et al. Ankyloglossia: a morphofunctional investigation in children. Oral Diseases. 2005; 11: 170–4.

[42] Kotlow LA. Ankyloglossia (tongue-tie): a diagnostic and treatment quandary. Quintessence International. 1999; 30: 259–62.

[43] Zhao C, Viana A, Ma Y, Capasso R. High tongue position is a risk factor for upper airway concentric collapse in obstructive sleep apnea: observation through sleep endoscopy. Nature and Science of Sleep. 2020; 12: 767–74.

[44] Kindgren E, Quinones Perez A, Knez R. Prevalence of ADHD and autism spectrum disorder in children with hypermobility spectrum disorders or hypermobile Ehlers-Danlos syndrome: a retrospective study. Neuropsychiatric Disease and Treatment. 2021; 17: 379–88.

[45] Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep and Breathing. 2017; 21: 1025–1032.

[46] Birk R, Stuck BA, Maurer JT, Schell A, Müller CE, Kramer B, et al. Maximum isometric tongue force in patients with obstructive sleep apnoea. European Archives of Oto-Rhino-Laryngology. 2021; 278: 893–900.

[47] Capasso R, Rosa T, Tsou DY, Nekhendzy V, Drover D, Collins J, et al. Variable findings for drug-induced sleep endoscopy in obstructive sleep apnea with Propofol versus Dexmedetomidine. Otolaryngology-Head and Neck Surgery. 2016; 154: 765–770.

[48] Soares D, Folbe AJ, Yoo G, Badr MS, Rowley JA, Lin HS. Drug-induced sleep endoscopy vs. awake Muller’s maneuver in the diagnosis of severe upper airway obstruction. Otolaryngology-Head and Neck Surgery. 2013; 148: 151–6.

[49] Barros JRC, Becker HMG, Pinto JA. Evaluation of atopy among mouth-breathing pediatric patients referred for treatment to a tertiary care center. Journal of Pediatrics. 2006; 82: 458–464.

[50] Prikladnicki A, Martinez D, Brunetto MG, Fiori CZ, Lenz M, Gomes E. Diagnostic performance of cheeks appearance in sleep apnea. Cranio. 2018; 36: 214–21.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 1.8 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time

Conferences

Top