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Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Polysomnographic findings are associated with cephalometric measurements in mouth-breathing children
Maria Ligia Juliano1, Marco Antonio Cardoso Machado, Luciane Bizari Coin de Carvalho
1Neuro-Sono Section, Department of Neurology, Universidade ederal de São Paulo, Brazil. lijuliano@ig.com.br
Insights
Mouth breathing children often have sleep disordered breathing linked to abnormal craniofacial morphology. Snoring and smaller airway spaces were key indicators in this study.
Area of Science:
- Pediatric Sleep Medicine
- Craniofacial Orthodontics
- Respiratory Physiology
Background:
- Adenotonsillar hypertrophy and abnormal craniofacial morphology predispose children to sleep disordered breathing (SDB).
- Mouth breathing is a common compensatory mechanism in children with SDB.
- The relationship between craniofacial structure and SDB in mouth breathers requires further investigation.
Purpose of the Study:
- To investigate the association between polysomnographic findings and cephalometric measurements in mouth-breathing children.
- To identify specific cephalometric indicators linked to SDB in this population.
Main Methods:
- A comparative study involving 27 children (7-14 years): 15 mouth breathers and 12 controls (nose breathers).
- Polysomnography assessed sleep parameters (e.g., apnea-hypopnea index, snoring, arousal index).
- Cephalometric analysis evaluated craniofacial morphology (e.g., jaw position, airway dimensions, hyoid position).
Main Results:
- Mouth breathers exhibited significantly higher rates of snoring and apnea-hypopnea index (AHI) > 1 compared to nose breathers.
- Mouth-breathing children were more likely to have a retruded mandible, steeper occlusal and mandibular planes, and reduced pharyngeal airway space.
- A decreased posterior airway space correlated with an increased apnea-hypopnea index.
Conclusions:
- An association exists between polysomnographic findings and cephalometric measures in mouth-breathing children.
- Snoring is a significant indicator of abnormal craniofacial morphology in these children.
- Orthodontists should consider sleep evaluation for mouth-breathing children with specific cephalometric findings like reduced superior pharyngeal airway or increased ANB, NS.PIO, or NS.GoGn.
Objectives:
Children with adenotonsillar hypertrophy and those with an abnormal craniofacial morphology are predisposed to having sleep disordered breathing; many of these children are mouth breathers. The aim of this study was to determine whether an association exists between polysomnographic findings and cephalometric measures in mouth-breathing children.
Methods:
Twenty-seven children (15 mouth-breathing children and 12 nose-breathing children [control subjects]), aged 7 to 14 years, took part in the study. Polysomnographic variables included sleep efficiency, sleep latency, apnea-hypopnea index, oxygen saturation, arousal index, number of periodic limb movements in sleep, and snoring. Cephalometric measures included maxilla and mandible position, occlusal and mandibular plane inclination, incisor position, pharyngeal airway space width, and hyoid bone position.
Results:
As compared with nose-breathing children, mouth breathers were more likely to snore (p < 0.001) and to have an apnea-hypopnea index greater than 1 (p = 0.02). Mouth-breathing children were also more likely to have a retruded mandible, more inclined occlusal and mandibular planes, a smaller airway space, and a smaller superior pharyngeal airway space (p < 0.01). The apnea-hypopnea index increased as the posterior airway space decreased (p = 0.05).
Conclusions:
Our study showed an association between polysomnographic data and cephalometric measures in mouth-breathing children. Snoring was the most important variable associated with abnormal craniofacial morphology. Orthodontists should send any mouth-breathing child for an evaluation of sleep if they find that the child has a small superior pharyngeal airway space or an increased ANB (the relationship between the maxilla and mandible), NS.PIO (occlusal plane inclination in relationship to the skull base), or NS.GoGn (the mandibular plane inclination in relation to the skull base), indicating that the child has a steeper mandibular plane.
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