Paediatric Sleep-Disordered Breathing Special Issue Introductory Editorial.

Sleep disordered breathing (SDB) affects 2%-11% of children, predisposing them to neurobehavioral and developmental consequences. Ankyloglossia has been proposed as a risk factor for SDB, and frenotomy as a treatment for SDB in children with ankyloglossia. With increasing ankyloglossia diagnoses, it is critical to evaluate the evidence for a linkage between SDB and ankyloglossia. EMBASE, Web of Science, Medline, CINAHL, CCRCT, and SCOPUS were searched from inception to February 13, 2025. Publications assessing the relationship between ankyloglossia and SDB in non-syndromic children ages 0 to 18 years were included. Eight studies involving 1171 patients met inclusion criteria. Two reviewers independently screened abstracts and full texts for inclusion. Strength of clinical data was graded according to the Cochrane Risk of Bias Assessment and modified Newcastle-Ottawa Scale. There is mixed evidence of a relationship between ankyloglossia and pediatric SDB. The lack of standardized diagnostic criteria for ankyloglossia and the use of surveys instead of validated clinical assessment tools to assess SDB limit the generalizability of findings. There is also insufficient data to conclude that frenotomy is indicated in managing SDB in children with ankyloglossia. While two interventional studies report a positive association, their results have limited validity and generalizability. There is an unclear relationship between ankyloglossia and pediatric SDB and insufficient evidence to determine if frenotomy is indicated as a treatment for SDB in children with ankyloglossia. Higher quality studies with standardized functional measures of ankyloglossia and validated assessment of SDB are needed. N/A.

There is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children. The study comprised in-depth qualitative interviews (n = 22) with parents of children (2-9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically. General practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed. Guidelines for the management of paediatric sleep-disordered breathing are needed.

Evaluate the association between pediatric sleep-disordered breathing (SDB) and executive functioning. We searched multiple electronic databases for peer-reviewed journal articles related to pediatric SDB and executive functioning. We included studies that assessed SDB via polysomnography, included objective or questionnaire measures of executive function, and had an age-matched control group. Fourteen articles met inclusion criteria with a total sample of 1697 children ages 5 to 17 years (M=9.81 years; SD=0.34). We calculated an overall effect size for each of the five executive domains (vigilance, inhibition, working memory, shifting, and generativity) as well as effect sizes according to SDB severity: mild, moderate, severe. We also calculated effect sizes separately for objective and subjective questionnaires of executive functioning. We found a medium effect size (-0.427) for just one of five executive function domains on objective neuropsychological measures (generativity). In contrast, effect sizes on all three executive domains measured via questionnaire data were significant, with effect sizes ranging from medium (-0.64) to large (-1.06). We found no difference between executive domains by severity of SDB. This meta-analysis of executive function separated into five domains in pediatric SDB suggested lower performance in generativity on objective neuropsychological measures. There were no differences associated with SDB severity. Questionnaire data suggested dysfunction across the three executive domains measured (inhibition, working memory, shifting). Overall, limited evidence suggested poorer performance in executive function in children with SDB according to objective testing, and subjective ratings of executive function suggested additional worsened performance. (JINS, 2016, 22, 839-850).

Pediatric sleep-disordered breathing(SDB) is a common sleep disorder in children caused by obstruction of upper airway during sleep. It is often unrecognized early in life and causes various complications, including abnormal craniofacial growth and oral muscle dysfunctions. Dentist can play a significant role in managing SDB by early screening SDB risk factors and timely referring for diagnosis. SDB risk factors can be easily screened in dental office through medical history, sleep history, physical factors, sleep questionnaire, and cephalometric x-ray. In case of abnormal craniofacial development, rapid maxillary expansion, oral appliances, and myofunctional therapy can be used to reduce SDB symptoms and restore normal craniofacial development and muscular tones. Understanding continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB is important in managing pediatric SDB. The ultimate goal of pediatric SDB treatment is to change mouth breathing to nasal breathing, and a multidisciplinary approach in medicine and dentistry is necessary.

Racial/ethnic and socioeconomic disparities in the diagnosis and treatment of sleep-disordered breathing in children

Objective: Pediatric sleep disordered breathing (SDB) is a common childhood disease with a potential risk of several comorbidities. The most common cause of SDB in childhood is upper airway obstruction due to adenotonsillar hypertrophy and the classical treatment is adenotonsillectomy. However, it carries a risk of many complications and persistent apnea. Topical nasal steroid treatment may be an alternative to surgery in the treatment of pediatric SDB. However, histopathological effects of topical nasal steroids are mostly understudied. Methods: A retrospective controlled clinical study in an academic tertiary referral center. A total of 110 children were involved in the study who underwent adenoidectomy for the treatment of SDB. The study group (51-children) was treated with topical nasal mometasone furoate monohydrate 100 mcg/day. The control group (59-children) was selected randomly and all had no history of topical nasal steroid pre-operatively. Post-operative adenoidectomy specimens were reviewed according to acute/chronic inflammation findings, follicular hyperplasia, goblet cell hyperplasia, squamous metaplasia, fibrosis, atrophy, ulcer and hemorrhage. The findings were scored semiquantitatively for statistical analysis. Results: Chronic inflammation findings, follicular hyperplasia and goblet cell hyperplasia were significantly decreased in the study group in addition fibrosis, atrophy and ulcer findings were significantly increased in the study group. However, there was no statistical difference between the groups according to acute inflammation and hemorrhage. Conclusion: Topical nasal corticosteroids significantly suppress the nasopharyngeal inflammatory process in SDB. This treatment may be an alternative to surgery at least in patients with mild and moderate disease.

Cranial base length in pediatric populations with sleep disordered breathing: A systematic review

Parental poverty and occupation as risk factors for pediatric sleep-disordered breathing

Comparison of Caregiver- and Child-Reported Quality of Life in Children With Sleep-Disordered Breathing.

Early in life impairment of orofacial growth leads to sleep-disordered breathing (SDB). Normal lingual gnosis and praxis are part of this early development related to the normal sensorimotor development of the tongue and surrounding oral musculature. The aim of this retrospective study was to explore if lingual praxia is impaired in both SDB children and adults and if there is an association to craniofacial morphology. The ability to perform simple tongue maneuvers was investigated in 100 prepubertal SDB children and 150 SDB adults (shown with polysomnography). All individuals had a clinical investigation by specialists to assess any orofacial growth impairment and the elements potentially behind this impairment. In a subgroup of individuals both able and unable to perform the maneuvers, we also performed a blind recognition of forms placed in the mouth. A subgroup of pediatric and adult SDB patients presented evidence not only of orofacial growth impairment, but also apraxia independent of age and severity of OSA. By 3 years of age, children should be able to perform requested tongue maneuvers and have oral form recognition. Abnormal gnosis-praxis was noted, independent of age in SDB children and adults, demonstrating that an abnormal functioning of the tongue in the oral cavity during early development can be detected. Both children and adults with SDB may present similar absences of normal oral development very early in life and a similar presentation of apraxia, suggesting that the distinction of SDB in children versus adults may not be relevant.

Adenotonsillectomy (T&A) may not completely eliminate sleep-disordered breathing (SDB), and residual SDB can result in progressive worsening of abnormal breathing during sleep. Persistence of mouth breathing post-T&As plays a role in progressive worsening through an increase of upper airway resistance during sleep with secondary impact on orofacial growth. Retrospective study on non-overweight and non-syndromic prepubertal children with SDB treated by T&A with pre- and post-surgery clinical and polysomnographic (PSG) evaluations including systematic monitoring of mouth breathing (initial cohort). All children with mouth breathing were then referred for myofunctional treatment (MFT), with clinical follow-up 6months later and PSG 1year post-surgery. Only a limited subgroup followed the recommendations to undergo MFT with subsequent PSG (follow-up subgroup). Sixty-four prepubertal children meeting inclusion criteria for the initial cohort were investigated. There was significant symptomatic improvement in all children post-T&A, but 26 children had residual SDB with an AHI > 1.5 events/hour and 35 children (including the previous 26) had evidence of "mouth breathing" during sleep as defined [minimum of 44% and a maximum of 100% of total sleep time, mean 69 ± 11% "mouth breather" subgroup and mean 4 ± 3.9%, range 0 and 10.3% "non-mouth breathers"]. Eighteen children (follow-up cohort), all in the "mouth breathing" group, were investigated at 1year follow-up with only nine having undergone 6months of MFT. The non- MFT subjects were significantly worse than the MFT-treated cohort. MFT led to normalization of clinical and PSG findings. Assessment of mouth breathing during sleep should be systematically performed post-T&A and the persistence of mouth breathing should be treated with MFT.

Changes in attention deficit and adipokine levels in children with sleep-disordered breathing.

Disparities in Pediatric Sleep-Disordered Breathing.

To determine whether there are racial/ethnic differences in the prevalence of pediatric snoring and sleep disordered breathing (SDB). In this cross-sectional study, parents or caretakers of 346 children, aged 2 through 6 years, attending well-child care visits at 5 general pediatric offices and clinics (3 academic, 2 private) in Brooklyn, NY completed the Sleep-Related Breathing Disorders Scale of the Pediatric Sleep Questionnaire (PSQ) along with a survey on demographics, prior treatment for SDB, and parental knowledge of pediatric SDB. The child's height and weight were recorded from the office visit. The prevalence of snoring was 13.9% (95% CI 10.2, 17.5) and of SDB was 9.4% (95% CI 6.3, 12.6). The odds of snoring for black children was 2.5 as great as for white children, and for Hispanic children was 2.3 as great as for white children (p = 0.031). There was a higher, non-statistically significant prevalence of abnormal PSQ scores in black and Hispanic children than white children. On multivariate analysis, only black race (OR 3.1 95% CI 1.1, 8.9) and prematurity (OR 4.4 95% CI 1.6, 12.4) were associated with snoring; male gender (OR 2.9 95% CI 1.1, 8.5) was associated with SDB. Knowledge regarding SDB was low among parents and caretakers. The degree of knowledge present was not associated with parental concern about snoring and discussion of the snoring with the child's pediatrician. Black race and prematurity are independent predictors of snoring. The degree of parental knowledge regarding SDB was not associated with seeking medical treatment.

Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is usually diagnosed clinically, with investigations such as polysomnography reserved for more complex cases. Management can involve watching and waiting, medical or adjunct treatments and adenotonsillectomy. National working groups have sought to standardise the pathway for surgery and improve the management of surgical and anaesthetic complications. Current guidelines use age, weight and comorbidities to stratify risk for these surgical cases. This article summarises these recommendations and outlines the important factors that indicate cases that may be more suitable for management in secondary and tertiary units. Appropriate case selection will reduce pressure on tertiary units while maintaining training opportunities in district general hospitals.