Mouth Breathing and Its Impact on Sleep Breathing Disorders in Children: A Cross-Sectional Study in Bandung, Indonesia

Purpose: Mouth breathing is an associated or characteristic feature of sleep-disordered breathing (SDB), not a direct cause. This study aims to investigate whether mouth-breathing children in Indonesia have a higher risk of SDB, as assessed by the Pediatric Sleep Questionnaire (PSQ) questionnaire. Patients and Methods: A cross-sectional study was conducted in three public elementary schools in Bandung (SDN 001 Merdeka, SDN 062 Ciujung, and SDN 054 Tikukur), involving 343 children aged 8– 9 years (193 boys, 150 girls). Clinical examinations were performed to identify mouth breathing habits, followed by administration of the PSQ questionnaire completed by parents. Prior to questionnaire completion, parents received standardized guidance via standardized online briefing sessions. Results: Mouth breathing was observed in 95 children (27.7%). PSQ scores were significantly higher in mouth breathers compared to non-mouth breathers (mean: 25.45% vs 7.93%; median: 19.05% vs 4.54%; range: 4.54– 58.82 vs 0.0– 45.46; p < 0.001). Furthermore, 41.1% of mouth-breathing children were identified as having SDB, in contrast to 9.7% of non-mouth breathers. The relative risk (RR) for SDB in mouth breathers was 4.24 (95% CI: 2.70– 6.65; p < 0.001). Conclusion: Mouth breathing in school-aged children is significantly associated with a higher risk of developing sleep-disordered breathing. These findings highlight the importance of early screening and timely intervention to prevent adverse health outcomes linked to SDB.