Abstract
Purpose
This study aimed to evaluate the severity of high-risk SDB in children and adolescents seeking paediatric dental care. Sleep-disordered breathing (SDB) has many untoward consequences that may interfere with children's health and is associated with several risk factors.
Methods
In this cross-sectional study, the convenience sample included 65 healthy children and adolescents aged 7–16. High-risk SDB breathing was assessed using the Paediatric-Sleep-Questionnaire consisting of 22 questions. High-risk was defined as a positive response to 33% or more of the questions. The clinical examination included: tonsils' size, Body-Mass Index, orthodontic examination, and enamel defects.
Results
In this sample of 65 children with a mean age of 9.75 (± 2.60) years; 36 (55.4%) were boys, and 29 (44.6%) were girls. Overall, 12.3% of children in the sample were at high-risk of SDB, and this was significantly associated with tonsils' size (P = 0.001), Body-Mass Index (P = 0.03), Class-II molar relationship (P = 0.03), and posterior crossbite/s (P = 0.02).
Conclusions
This study suggested that approximately 12% of the sample studied were potentially at risk of SDB. Tonsils' size, Body-Mass Index, Class-II molar relationship, and posterior crossbite/s were positively associated with the risk of SDB. Therefore, the importance of investigating the risk for sleep-disordered breathing should not be disregarded.
Similar content being viewed by others
Availability of data and material
Available upon request.
Change history
21 March 2022
A Correction to this paper has been published: https://doi.org/10.1007/s40368-022-00705-x
References
Angle EH. ‘Angle’s classification of malocclusion. Dental Cosmos. 1899;41(3):248–64.
Aroucha Lyra MC, et al. Prevalence of sleep-disordered breathing and associations with malocclusion in children. J Clin Sleep Med. 2020. https://doi.org/10.5664/jcsm.8370.
ASA (2012) American Society of Anesthesiologists: ASA Physical Status Classification System, American Society of Anesthesiologists Web site. http://www.asahq.org/clinical/physicalstatus.htm. Accessed: 3 Mar 2020.
Baidas L, et al. Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children. BMC Oral Health Biomed Central. 2019;19(1):43. https://doi.org/10.1186/s12903-019-0735-3.
Bavis RW. Developmental plasticity of the hypoxic ventilatory response after perinatal hyperoxia and hypoxia. Respir Physiol Neurobiol. 2005;149(1–3):287–99. https://doi.org/10.1016/j.resp.2005.04.003.
Bjoerk A, Krebs A, Solow B. A method for epidemiological registration of malocclusion. Am J Orthod Elsevier. 1966;52(4):306–7. https://doi.org/10.1016/0002-9416(66)90175-8.
Blunden S, et al. Symptoms of sleep breathing disorders in children are underreported by parents at general practice visits. Sleep Breath. 2003;7(4):167–76. https://doi.org/10.1055/s-2003-814762.
Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin N Am. 1989;36(6):1551–69. https://doi.org/10.1016/S0031-3955(16)36806-7.
Brunetti L, et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of Southern Italy. Chest. 2001;120(6):1930–5. https://doi.org/10.1378/chest.120.6.1930.
Calhoun SL, et al. Prenatal and perinatal complications: Is it the link between race and SES and childhood sleep disordered breathing? J Clin Sleep Med. 2010;6(3):264–9. https://doi.org/10.5664/jcsm.27824.
Carvalho FR, et al. Sleep-disordered breathing and orthodontic variables in children-Pilot study. Int J Pediatr Otorhinolaryngol. 2014;78(11):1965–9. https://doi.org/10.1016/j.ijporl.2014.08.040.
Chaicharn J, et al. Model-based assessment of cardiovascular autonomic control in children with obstructive sleep apnea. Sleep. 2009;32(7):927–38. https://doi.org/10.1093/sleep/32.7.927.
Chervin RD, et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1(1):21–32. https://doi.org/10.1016/S1389-9457(99)00009-X.
Erickson JT, et al. Chemoafferent degeneration and carotid body hypoplasia following chronic hyperoxia in newborn rats. J Physiol. 1998;509(2):519–26. https://doi.org/10.1111/j.1469-7793.1998.519bn.x.
Frascino S, et al. Molar-incisor enamel hypomineralization cross-sectional prevalence evaluation in oral-breathing allergic children. Clin Lab Res Dent. 2018. https://doi.org/10.11606/issn.2357-8041.clrd.2017.134317.
Ghanim A, et al. Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice. Eur Arch Paediatr Dent. 2017;18(4):225–42. https://doi.org/10.1007/s40368-017-0293-9.
Giudice LC, et al. Insulin-like growth factors and their binding proteins in the term and preterm human fetus and neonate with normal and extremes of intrauterine growth. J Clin Endocrinol Metab. 1995;80(5):1548–55. https://doi.org/10.1210/jcem.80.5.7538146.
Goldstein NA, et al. Racial/ethnic differences in the prevalence of snoring and sleep disordered breathing in young children. J Clin Sleep Med. 2011;7(2):163–71. https://doi.org/10.5664/jcsm.28104.
Goldstein NA, et al. The prevalence of sleep-disordered breathing in children with asthma and its behavioral effects. Pediatr Pulmonol. 2015;50(11):1128–36. https://doi.org/10.1002/ppul.23120.
Goyal A, Bhatt G, Pakhare A. Prevalence and complications of OSA: a study among school children of India. Paediatr Respir Physiol Sleep. 2016. https://doi.org/10.1183/13993003.congress-2016.pa380.
Growth Charts—2000 CDC Growth Charts—United States (2002). http://www.cdc.gov/growthcharts/cdc_charts.htm. Accessed: 11 May 2020.
Guilleminault C, Stoohs R. Chronic snoring and obstructive sleep apnea syndrome in children. Lung. 1990;168(1):912–9. https://doi.org/10.1007/BF02718227.
Kawashima S, et al. Craniofacial morphology in preschool children with sleep-related breathing disorder and hypertrophy of tonsils. Acta Paediatr Int J Paediatr. 2002;91(1):71–7. https://doi.org/10.1080/080352502753457996.
Kim D, et al. Relationship between upper airway and sleep-disordered breathing in children with mouth breathing. J Korean Acad Pedtatr Dentist. 2019;46(1):38–47. https://doi.org/10.5933/jkapd.2019.46.1.38.
Kumar DS, et al. The reliability of clinical tonsil size grading in children. JAMA Otolaryngol Head Neck Surg. 2014;140(11):1034–7. https://doi.org/10.1001/jamaoto.2014.2338.
Li AM, et al. Use of tonsil size in the evaluation of obstructive sleep apnoea. Arch Dis Child. 2002;87(2):156–9. https://doi.org/10.1136/adc.87.2.156.
Lin CM, Davidson TM, Ancoli-Israel S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev NIH Public Access. 2008;12(6):481–96. https://doi.org/10.1016/j.smrv.2007.11.003.
Loghmanee DA, Sheldon SH. ‘Pediatric obstructive sleep apnea: an update. Pediatric Ann. 2010. https://doi.org/10.3928/00904481-20101116-09.
Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):242–52. https://doi.org/10.1513/pats.200708-135MG.
Marcus CL, et al. Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol. 1996;21(3):176–83. https://doi.org/10.1002/(SICI)1099-0496(199603)21:3%3c176::AID-PPUL5%3e3.0.CO;2-O.
Marcus CL, et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatr Am Acad Pediatr. 2006;117(3):e442–51. https://doi.org/10.1542/peds.2005-1634.
Monahan KJ, et al. Utility of noninvasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing. Am J Respir Crit Care Med. 2002;165(11):1499–503. https://doi.org/10.1164/rccm.200111-061OC.
National Sleep Foundation (2016) Caffeine & Sleep Problems—National Sleep Foundation. https://sleepfoundation.org/sleep-topics/caffeine-and-sleep. Accessed: 27 May 2019.
Nelson S, Cakirer B, Lai YY. Longitudinal changes in craniofacial factors among snoring and nonsnoring Bolton–Brush study participants. Am J Orthod Dentofac Orthop. 2003;123(3):338–44. https://doi.org/10.1067/mod.2003.85.
Nolan J, Brietzke SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg. 2011. https://doi.org/10.1177/0194599811400683.
Pirila-Parkkinen K, et al. Dental arch morphology in children with sleep-disordered breathing. Eur J Orthod. 2009;31(2):160–7. https://doi.org/10.1093/ejo/cjn061.
Raynes-Greenow CH, et al. Sleep apnea in early childhood associated with preterm birth but not small for gestational age: a population-based record linkage study. Sleep. 2012;35(11):1475–80. https://doi.org/10.5665/sleep.2192.
Rohra AK, et al. ‘Sleep disordered breathing in children seeking orthodontic care. Am J Orthod Dentofac Orthop. 2018a;154(1):65–71. https://doi.org/10.1016/j.ajodo.2017.11.027.
Rohra AK, et al. Sleep disordered breathing in children seeking orthodontic care. Am J Orthod Dentofac Orthop. 2018b;154(1):65–71. https://doi.org/10.1016/j.ajodo.2017.11.027.
Rudnick EF, et al. ‘Prevalence and ethnicity of sleep-disordered breathing and obesity in children. Otolaryngol Head Neck Surg. 2007;137(6):878–82. https://doi.org/10.1016/j.otohns.2007.08.002.
Shintani T, Asakura K, Kataura A. Evaluation of the role of adenotonsillar hypertrophy and facial morphology in children with obstructive sleep apnea. ORL. 1997;59(5):286–91. https://doi.org/10.1159/000276955.
Sogut A, et al. Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3–11-year-old Turkish children. Pediatr Pulmonol. 2005;39(3):251–6. https://doi.org/10.1002/ppul.20179.
Sulaiman N, et al. Prevalence of overweight and obesity in United Arab Emirates expatriates: the UAE National Diabetes and Lifestyle Study. Diabetol Metab Syndr. 2017;9(1):88. https://doi.org/10.1186/s13098-017-0287-0.
Tamasas B, Nelson T, Chen M. Oral health and oral health-related quality of life in children with obstructive sleep apnea. J Clin Sleep Med. 2019;15(3):445–52. https://doi.org/10.5664/jcsm.7672.
Van Litsenburg RRL, et al. Sleep habits and sleep disturbances in Dutch children: a population-based study. Eur J Pediatr. 2010;169(8):1009–15. https://doi.org/10.1007/s00431-010-1169-8.
Vats MG, et al. Obesity and sleep-related breathing disorders in Middle East and UAE. Can Respir J. 2016. https://doi.org/10.1155/2016/9673054.
von Elm EMFL. STROBE statement—checklist of items that should be included in reports of observational studies (© STROBE Initiative). Int J Public Health. 2008;53(1):3–4. https://doi.org/10.1007/s00038-007-0239-9.
Wei JL, et al. Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg. 2007;133(10):974–9. https://doi.org/10.1001/archotol.133.10.974.
WHO (2017) WHO|Process of translation and adaptation of instruments, WHO. World Health Organization. https://www.who.int/substance_abuse/research_tools/translation/en/. Accessed: 18 Mar 2020.
Wing YK, et al. A controlled study of sleep related disordered breathing in obese children. Arch Dis Child. 2003;88(12):1043–7. https://doi.org/10.1136/adc.88.12.1043.
Witmans M, Young R. Update on pediatric sleep-disordered breathing. Pediatr Clin N Am. 2011;58(3):571–89. https://doi.org/10.1016/j.pcl.2011.03.013.
World Health Organization. Basic methods. Lect Notes Econ Math Syst. 2011. https://doi.org/10.1007/978-3-642-20479-1_4.
Funding
This study was not funded.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval
This study was approved by MBRU-IRB Committee.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Abdalla, M., Halabi, M., Kowash, M. et al. Sleep-disordered breathing in children and adolescents seeking paediatric dental care in Dubai, UAE. Eur Arch Paediatr Dent 23, 485–494 (2022). https://doi.org/10.1007/s40368-022-00697-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40368-022-00697-8