Pediatric craniofacial risk factors for sleep-disordered breathing in dental and orthodontic practice settings: an observational pilot study

Background: Pediatric sleep-disordered breathing (SDB) is highly prevalent and associated with craniofacial risk factors, including malformations of the maxilla, mandible, and other features not routinely assessed clinically. This study evaluated craniofacial risk factors associated with SDB symptoms in children presenting for routine dental care. Methods: Children aged 5–12 years were recruited from pediatric dental practices in nine U.S. cities. The primary outcome was SDB as defined by the Pediatric Sleep Questionnaire—Sleep-Related Breathing Disorder (PSQ-SRBD) questionnaire. Regression analyses modeled the association between PSQ-SRBD, the 21 individual craniofacial features, as well as the total number of craniofacial risk factors. A subset of participants underwent a blinded duplicate craniofacial assessment to evaluate inter-rater reliability. Results: The sample included 141 children (75% Non-Hispanic-White, 12%Hispanic, 9% Non-Hispanic-Black, 4% other; 50% female), with a mean age (standard deviation) of 8.6 (2.3) years, presenting for routine dental care. PSQ-SRBD scores were ≥0.33, signifying increased SDB risk in 28 (20%) children. Increased risk for SDB was associated with the total number of craniofacial risk factors, odds ratio (OR) of 1.16 (95% confidence interval (CI): 1.01–1.35, p = 0.035); as well as with specific individual features including a narrow palate: 3.47 (1.34–9.07, p = 0.010), open bite: 5.61 (1.36–23.63, p = 0.016), tongue thrust: 11.33 (1.98–75.19, p = 0.007), and a heart-shaped tongue: 7.41 (1.48–39.38, p = 0.014) after adjustment for age, sex, race, and ethnicity. There was moderate inter-rater reliability (kappa statistic: 0.76, 95% CI: 0.63–0.89) in the subset of 54 subjects with duplicate craniofacial assessments. Conclusions: Multiple craniofacial features assessed during routine dental visits were associated with an increased risk for pediatric SDB. This study supports the utility and feasibility of systematic craniofacial screening by dental providers to identify children at risk for SDB and facilitate timely referral and intervention.

Craniofacial; Dentist; Obstructive sleep apnea; OSA; Pediatric

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