What does this research mean for the field?

Sleep-disordered breathing (SDB) is prevalent in children, with a 28.9% baseline prevalence, and is significantly associated with craniofacial morphology and malocclusion, while targeted interventions like adenotonsillectomy and orthodontic treatment improve outcomes. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The study aims to assess the relationships between sleep-disordered breathing and craniofacial features, while evaluating intervention efficacy in children.

February 26, 2026Open Access

A longitudinal cohort study of sleep-disordered breathing in children: interrelationships with craniofacial morphology, malocclusion, and intervention outcomes

Key Points

The study aims to assess the relationships between sleep-disordered breathing and craniofacial features, while evaluating intervention efficacy in children.
Prospective longitudinal cohort study design.
1,589 children aged 6-9 years assessed over 36 months.
Used portable polysomnography, cone-beam computed tomography, and 3D facial imaging.
Sub-study involved 275 children with moderate-to-severe sleep-disordered breathing receiving various interventions.
Multivariate analysis identified key risk factors and associations with craniofacial features.
Baseline prevalence of sleep-disordered breathing was 28.9%.
Key independent risk factors identified included adenotonsillar hypertrophy, paternal snoring, obesity, and allergic rhinitis.
Distinct craniofacial features included reduced airway volume and smaller cross-sectional area.
Interventions showed significant resolution rates: ENT (68.4%) and orthodontic (52.1%) compared to control (15.7%).
Cost-effectiveness analysis favored ENT intervention, recognizing orthodontic benefits.

Abstract

This prospective longitudinal cohort study aimed to investigate the prevalence, risk factors, and craniofacial correlates of sleep-disordered breathing (SDB) in children, and to evaluate the efficacy of targeted interventions in a nested sub-study. A total of 1,589 children (aged 6–9 years) were enrolled and followed for 36 months. Assessments included Portable polysomnography, cone-beam computed tomography, 3D facial imaging, and standardized clinical examinations. A sub-study of 275 children with moderate-to-severe SDB (obstructive apnea–hypopnea index, OAHI ≥ 5) were allocated to ENT intervention (adenotonsillectomy), orthodontic intervention (rapid maxillary expansion), or control groups. The baseline prevalence of SDB was 28.9%, with a significant male predominance. Multivariate analysis identified adenotonsillar hypertrophy (aOR = 3.42), paternal snoring (aOR = 2.38), obesity (aOR = 2.15), and allergic rhinitis (aOR = 1.86) as key independent risk factors. Children with SDB exhibited distinct craniofacial features, including reduced airway volume, mandibular retrusion, and a 38.2% smaller minimum cross-sectional area. Strong associations were found between SDB and specific malocclusions, including Class II malocclusion (48.6% vs. 27.3%), increased overjet, and posterior crossbite. A bidirectional relationship was observed, where SDB persistence worsened occlusal traits, while SDB remission facilitated spontaneous improvement. In the intervention sub-study, both ENT (68.4% resolution) and orthodontic (52.1% resolution) groups showed significant improvement in OAHI and quality of life scores compared to controls (15.7%). Cost-effectiveness analysis favored the ENT intervention while acknowledging the additional occlusal benefits of orthodontic treatment. SDB is highly prevalent and dynamically interacts with craniofacial growth and occlusal development in children. An interdisciplinary approach, incorporating both ENT and orthodontic perspectives, is supported for effective management, leading to improved respiratory, dentofacial, and quality-of-life outcomes.

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Cite This Study

Zhu et al. (Wed,) studied this question.

synapsesocial.com/papers/699fe3f995ddcd3a253e816e https://doi.org/https://doi.org/10.1186/s12903-026-07791-z

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