Association between clinical signs and symptoms related to sleep-disordered breathing in mouth breathers school children

Abstract

Introduction Sleep-disordered breathing (SDB) is one of the causes of morbidity in children. The symptoms of SDB in children are varied and difficult to diagnose, especially in mouth breathing children (MB). The aim of this study was to associate the clinical signs of the MB and the self-perception of their symptoms related to SDB, focusing on nasal, sleep and masticatory problems. Materials and methods From a previous study, a sample of 73 pre-selected MB derived from elementary schools, aged 7–14 years old, was reevaluated about the presence of anatomical and functional facial and dental occlusion changes, the temporomandibular joint (TMJ) and posture alterations and breathing pattern abnormalities. Concomitantly, a questionnaire about symptoms of SDB was applied to the MB. This instrument contains 16 questions about TMJ, nasal and sleep problems. From 42 clinical variables reevaluated, 19 were selected by the Binomial test where the cutoff point was the average of the variables’ prevalence. Afterwards, we used the logistic regression through Backward method and the Wald test to verify the association between these clinical variables and the 16 questions from the questionnaire. Results For TMJ symptoms the clinical variables were significant to: lack of lip closure, Class II malocclusion, deviation from interocclusal position, overbite, forward head position and palatine tonsil hypertrophy. For the nasal symptoms the clinical variables were significant to: turbinate hypertrophy and deviation from interocclusal position. Lastly, for the sleep symptoms the clinical variables were significant to: turbinate hypertrophy, palatine tonsils hypertrophy, deviation from interocclusal position, lack of lip seal, obstructive Mallampati index (III and IV), and protrusion deviation. Most significant finds were those related to the sleep symptoms: mouth breathing and obstructive Mallampati index were related to complaints of snoring, waking up during the night and sleeping were related with the mouth open; mouth breathing and palatine tonsils hypertrophy were related to complaints of sleep problems and daytime sleepiness. Conclusion This study showed that craniofacial, upper airway and postural abnormalities are associated with an increased risk of SDB in mouth breathers children. Acknowledgements Management of Vitoria City, ES, Brazil.