The prevalence of symptoms of sleep-disordered breathing in Brazilian schoolchildren

Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing

Aims and objectives

Persistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing.

Materials and methods

A cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children's sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson's correlation coefficient test were utilized during the analysis. p value of <0.05 was considered significant.

Results

Out of 100 children, 70 were males and 30 were females. On the CSHQ scale, the highest score was found on sleep-disordered breathing followed by sleep onset delay and daytime sleepiness. The commonest symptom of inattention was “failing to give close attention in school” (73%) whereas the commonest symptom of hyperactivity was “trouble waiting for his/her turn” (66%). Seven participants satisfied complete criteria for ADHD. Sleep duration and daytime sleepiness had a significant negative correlation with hyperactivity (p < 0.05). A positive correlation was observed between daytime sleepiness and inattention (p < 0.01).

Conclusion

Children with sleep disturbances or ADHD should be assessed for the presence of mouth breathing, as early identification and correction of mouth breathing may help to prevent unnecessary exposure to the medication.

Clinical significance

Children with ADHD or sleep disturbances should always be assessed for the presence of mouth breathing. Early identification and correction of mouth breathing may help in preventing unnecessary exposure to medication for treating ADHD.

How to cite this article

Kalaskar R, Bhaje P, Kalaskar A, et al. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Mouth Breathing. Int J Clin Pediatr Dent 2021;14(5):604–609.

Prevalence of sleep-disordered breathing and associated risk factors in primary school children in urban and rural environments

INTRODUCTION

Sleep-disordered breathing (SDB) in primary school children is a significant problem, yet its prevalence is not well known outside large urban settings. Information on the burden and risk factors of SDB in children could be used to improve resource allocation when providing care across a large country. The objectives of this study were to assess the prevalence of SDB among school-aged children comparing rural and urban settings, and to investigate associated risk factors.

METHODS

In this cross-sectional study, a random sample of primary school students in Turkey were selected from urban and rural areas and data were collected using the Pediatric Sleep Questionnaire, asthma, and allergic rhinitis questionnaires completed by the parents.

RESULTS

Questionnaires were collected from a total of 139 schools from 58 provinces. A total of 11,013 students were contacted, and 9045 (73%) completed the study. There was no difference in the prevalence of SDB between rural and urban settings (16% vs. 15%, p = 0.612). Multivariate logistic regression analysis revealed that current wheezing, current rhinoconjunctivitis, being overweight, parental snoring, and current mold at home were significant risk factors for SDB in both rural and urban children. Current tobacco smoke exposure (OR = 1.48, 95%CI = 1.19-1.85), near roadway air pollution exposure (OR = 1.40, 95%CI = 1.108-1.791), and mold at home in the first year of life (OR = 1.68, 95%CI = 1.26-2.23) were associated with SDB in urban children. History of maternal/paternal adenotonsillectomy was a significant predictor of SDB in the rural setting (OR = 1.63, 95%CI = 1.12-2.39).

CONCLUSION

The prevalence of SDB is high in children living in both settings but associated risk factors may vary. Children residing in rural areas should also be screened for sleep-disordered breathing during routine health visits.

Sleep Clinical Record application in Brazilian children and its comparison with Italian children

Objective

To apply the Sleep Clinical Record (SCR) to a sample of Brazilian children with sleep complaints, to compare the results with Italian children, and to identify variables that influence phenotype.

Methods

Brazilian and Italian children, 4-11 years of age and matched for age, gender, obesity, and apnea-hypopnea index and who presented with complaints related to sleep, were selected. The instrument used was the SCR, and the procedure used was full-night cardiorespiratory monitoring.

Results

The sample consisted of 51 Brazilian children and 102 Italian children. Brazilian children presented with oral breathing (55%), tonsillar hypertrophy (69%), Friedman palate position (88%), malocclusion (84%), and OSAS score (Brouilette questionnaire) (55%). The SCR among obese Brazilian children was higher as compared to that in nonobese subjects (obese, 10.84 vs nonobese, 9.13; p = 0.03). In the comparison between Brazilian and Italian children, the total Brazilian SCR was higher than the Italian SCR score (Brazilian SCR, 10.21 ± 7.56; Italian SCR, 8.95 ± 2.55; p = 0.002). The Italian SCR score was influenced by obesity, whereas the Brazilian SCR was influenced by others symptoms (daytime sleepiness, enuresis, nocturnal choking, headache, limb movements).

Conclusion

Brazilian children with sleep-disordered breathing show a higher SCR score as compared to Italian children. Obesity and tonsillar hypertrophy, Friedman palate position alteration, and dental malocclusion further influenced the total SCR score among Brazilian children. This may be due to access difficulties in Brazil where children should have more assistance to obtain medical care.

Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children

Background

This study aimed to determine the prevalence of sleep-disordered breathing among primary school children in Riyadh, Saudi Arabia, and to evaluate associations between sleep-disordered breathing and respiratory conditions/orofacial symptoms.

Methods

In this cross-sectional study, 1600 questionnaires were distributed to Saudi boys and girls aged 6–12 years from 16 primary schools in Riyadh. The questionnaire covered relevant demographic and personal characteristics, presence of respiratory conditions and orofacial symptoms, and the Pediatric Sleep Questionnaire. The latter was used to assess the prevalence of symptoms of sleep-disordered breathing and was completed by the participating children’s parents.

Results

In total, 1350 completed questionnaires were returned (85% response rate). The children’ mean age was 9.2 ± 1.8 years; 733 (54.3%) were boys and 617 (45.7%) girls. Overall, 21% of children were at high risk of sleep-disordered breathing. The prevalence of snoring was 14.4% and that of sleep apnea 3.4%. Boys were at higher risk of sleep-disordered breathing than girls (P = 0.040). Children with respiratory conditions or orofacial symptoms were at higher risk of sleep-disordered breathing (P < 0.0001) than children without these conditions/symptoms.

Conclusions

Around 21% of Saudi children are at risk of sleep-disordered breathing. There is a strong association between sleep-disordered breathing symptoms and the presence of respiratory conditions or orofacial symptoms.

Guidelines proposal for clinical recognition of mouth breathing children

INTRODUCTION:

Mouth breathing (MB) is an etiological factor for sleep-disordered breathing (SDB) during childhood. The habit of breathing through the mouth may be perpetuated even after airway clearance. Both habit and obstruction may cause facial muscle imbalance and craniofacial changes.

OBJECTIVE:

The aim of this paper is to propose and test guidelines for clinical recognition of MB and some predisposing factors for SDB in children.

METHODS:

Semi-structured interviews were conducted with 110 orthodontists regarding their procedures for clinical evaluation of MB and their knowledge about SDB during childhood. Thereafter, based on their answers, guidelines were developed and tested in 687 children aged between 6 and 12 years old and attending elementary schools.

RESULTS:

There was no standardization for clinical recognition of MB among orthodontists. The most common procedures performed were inefficient to recognize differences between MB by habit or obstruction.

CONCLUSIONS:

The guidelines proposed herein facilitate clinical recognition of MB, help clinicians to differentiate between habit and obstruction, suggest the most appropriate treatment for each case, and avoid maintenance of mouth breathing patterns during adulthood.

Is the difference in the volume of the pharyngeal space, as measured by acoustic pharyngometry, before and after tonsillectomy proportional to the volume of the excised tonsils?

OBJECTIVE

Adenotonsillectomy is recognized as an effective therapy for snoring and sleep disorders in children. It is important to understand whether adenotonsillectomy significantly increases the volume of the pharyngeal space. The goal of this study was to evaluate the change in oropharyngeal volume after adenotonsillectomy and the correlation of this change with the objective volume of the tonsils and body mass index.

METHODS

We included 27 subjects (14 males) with snoring caused by tonsil and adenoid hypertrophy. The mean age of the subjects was 7.92 (±2.52) years. Children with craniofacial malformations or neuromuscular diseases or syndromes were excluded. The parents/caregivers answered an adapted questionnaire regarding sleep-disordered breathing. All patients were subjected to weight and height measurements and body mass index was calculated. The subjects underwent pharyngometry before and after adenotonsillectomy and the volume of both excised tonsils together was measured in cm3 in the operating room.

RESULTS

Pharyngometric analysis showed that the mean pharyngeal volume was 28.63 (±5.57) cm3 before surgery and 31.23 (±6.76) cm3 after surgery; the volume of the oropharynx was significantly increased post-surgery (p=0.015, Wilcoxon test). No correlation was found between the objective tonsil volume and the post-surgical volume increase (p=0.6885). There was a fair correlation between the oropharyngeal volume and body mass index (p=0.0224).

CONCLUSION

Adenotonsillectomy increases the volume of the pharyngeal space, but this increase does not correlate with the objective tonsil size. Furthermore, greater BMI was associated with a smaller increase in the pharyngeal volume. Oropharyngeal structures and craniofacial morphology may also play a role in the increase in oropharyngeal volume.

Habitual snoring in school-aged children: environmental and biological predictors

Background

Habitual snoring, a prominent symptom of sleep-disordered breathing, is an important indicator for a number of health problems in children. Compared to adults, large epidemiological studies on childhood habitual snoring and associated predisposing factors are extremely scarce. The present study aimed to assess the prevalence and associated factors of habitual snoring among Chinese school-aged children.

Methods

A random sample of 20,152 children aged 5.08 to 11.99 years old participated in a cross-sectional survey, which was conducted in eight cities of China. Parent-administrated questionnaires were used to collect information on children's snoring frequency and the possible correlates.

Results

The prevalence of habitual snoring was 12.0% (14.5% for boys vs. 9.5% for girls) in our sampled children. Following factors were associated with an increased risk for habitual snoring: lower family income (adjusted odds ratio [OR] = 1.46), lower father's education (OR = 1.38 and 1.14 for middle school or under and high school of educational level, respectively), breastfeeding duration < 6 months (OR = 1.17), pregnancy maternal smoking (OR = 1.51), obesity (OR = 1.50), overweight (OR = 1.35), several respiratory problems associated with atopy and infection, such as chronic/allergic rhinitis (OR = 1.94), asthma (OR = 1.43), adenotonsillar hypertrophy (OR = 2.17), and chronic otitis media (OR = 1.31), and family history of habitual snoring (OR = 1.70).

Conclusion

The prevalence of habitual snoring in Chinese children was similar to that observed in other countries. The potential predisposing factors covered socioeconomic characteristics, environmental exposures, chronic health problems, and family susceptibility. Compared to socioeconomic status and family susceptibility, environmental exposures and chronic health problems had greater impact, indicating childhood habitual snoring could be partly prevented by health promotion and environmental intervention.