Prevalence of Sleep-Related Breathing Disorders in Children: Exploring Links Between Obstructive Sleep Apnea and Dental Disorders – A Questionnaire-Based Cross-Sectional Study

Prevalence of Sleep-Related Breathing Disorders in Children: Exploring Links Between Obstructive Sleep Apnea and Dental Disorders – A Questionnaire-Based Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Sleep-Related Breathing Disorders in Children: Exploring Links Between Obstructive Sleep Apnea and Dental Disorders – A Questionnaire-Based Cross-Sectional Study Himanshi Patel, Dr Rashi Dubey, Dr Nilima Thosar, Dr Neha Pankey, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8607189/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Introduction: Paediatric obstructive sleep apnoea (OSA) is a sleeping-disordered breathing condition widely neglected that can negatively affect the dental and systemic health of a child. The symptoms are often associated with behavioural or developmental abnormalities, and thus, it is not easy to diagnose in the early stages. OSA in untreated conditions may cause dental issues, impairment of craniofacial development, and a decrease in the overall quality of life. Dental professionals are in a distinctive position to identify warning signs early, as they may be the first to identify oral disease manifestations like malocclusion and bruxism, as well as oral hygiene issues. Therefore, the Dental practitioners have a very critical role in early screening and referral, as they are in a unique position to screen the oral symptoms of OSA. Purpose and the setting: This paper employed a validated questionnaire and clinical assessment to determine the connection between paediatric OSA and dental issues in children. Paediatric obstructive sleep apnoea (OSA) is an undiagnosed but common sleep disorder that can have a significant negative effect on systemic and oral health. Early detection of OSA and the associated dental symptoms is necessary to prevent the impact on behaviour, functional, and developmental problems in the long-term. Material and Methods: Wardha Sharad Pawar Dental College, 60 children aged 6-12 years were subject to a cross-sectional study (30 males and 30 females). Parents were provided with a questionnaire containing a few questions in order to determine the symptoms related to sleep using a validated questionnaire. The questionnaire to be used in the given study was based on the Paediatric Sleep Questionnaire (PSQ). The questionnaire was modified to simplify it so that the parents could easily understand it and fill it in accordingly. Clinical examination tests that were performed include Mallampati classification, bruxism, temporomandibular disorders, facial profile, tonsillar hypertrophy (Brodsky-score), malocclusion (Angle classification), dental caries (G.V. Black classification), and oral hygiene status. The data has been assembled using descriptive statistical analysis. Results: Snoring (63.3), daytime sleepiness (75%), and behaviour change were the most frequent OSA-related symptoms (71.6%). The prevalence of dental caries (76.6%), poor oral health (88.3%), and halitosis (61.6%) was observed among affected children, and malocclusion was observed in 30% (Class I), 41.6% (Class II), and 28.4% (Class III) of the participants. According to the Mallampati classification, 71.7 percent of children had a Class III-IV, and 53.3 percent of children had Grade 3-4 tonsillar hypertrophy. The other symptoms were bruxism (21.6), temporomandibular disorders (16.6), and a changed facial profile (18.3). Conclusion: The study demonstrated the reciprocal impact of airway obstruction on oral health, as it demonstrated that there was a significant correlation between paediatric OSA and dental- related issues. Early detection of the symptoms of OSA in dental practice can assist dental practitioners in referring and multidisciplinary care. The practice of screening children for sleep-disordered breathing by dentists can significantly enhance both oral and systemic health of children. obstructive sleep apnoea breathing disorder oral health dental caries snoring daytime sleepiness oral hygiene malocclusion INTRODUCTION Obstructive sleep apnoea (OSA) and persistent snoring are the two main respiratory disorders that fall under the umbrella of sleep-disordered breathing (SDB). The incidence of OSA in children is thought to be between 1% and 5%. Still, since its clinical symptoms can be confused with those of other behavioural and developmental issues, it is often underdiagnosed. The pathophysiological definition of OSA is characterised by recurrent episodes of partial or whole upper airway collapse during sleep, which can cause hypercapnia, intermittent hypoxia, and disturbance of the regular sleep architecture. Apnoea (airflow halt) or hypopnea (airflow reduction) are the symptoms of OSA [ 1 ] . Long-term symptoms of OSA have been linked to behavioural issues, emotional dysregulation, learning disabilities, and metabolic and cardiovascular issues [ 1 , 2 ] . The longer the duration of sleep-related breathing problems, the more significant the associated symptoms are. Children are in the growing stages and thus any changes in their mental and physical states associated with SDB could bring about significant changes in a child’s life and may affect their social potential [ 1 , 2 ] . Oral health is an essential component of overall systemic health, and children with OSA have increased risks of malocclusions, periodontal problems, and caries. Children with OSA require a dental professional to maintain and treat them with quality care since poor oral health impairs a person's capacity to eat, sleep, and function [ 2 ] . There are many syndromes and genetic disorders that are also associated with OSA, such as cleft palate, cerebral palsy, Turner’s syndrome, and Pierre Robin syndrome [ 3 ] . Paediatric OSA is characterised by disturbed nocturnal sleep, snoring, difficulty focusing at school, daytime sleepiness, behavioural problems, and trouble organising duties and activities [ 1 , 4 ] . These correlations suggest a reciprocal relationship: OSA itself may exacerbate oral health problems, while craniofacial and dental abnormalities may increase a child's susceptibility to airway obstruction. This overlap emphasises the importance of orthodontists and paediatric dentists in the early detection and treatment of paediatric OSA [ 5 , 6 ] . This background informed the design of the current study, which used a validated questionnaire-based survey in conjunction with a clinical dental examination to evaluate the relationship between paediatric OSA and dental-related disorders in a cohort of children aged 6–12. This study supports the evidence foundation for the importance of Dentistry in Paediatric OSA screening and to promote early interdisciplinary care options by assessing important factors such as airway obstruction, tonsillar size, malocclusion, dental hygiene, and caries status [ 1 , 4 – 7 ] . STUDY OBJECTIVES- Employing a structured questionnaire, determine the prevalence of paediatric obstructive sleep apnoea (OSA) and sleep-related respiratory problems in children aged 6–12. To assess the relationship between common dental diseases such as halitosis, bruxism, dental caries, malocclusion, poor oral hygiene, and temporomandibular disorders (TMD) and paediatric OSA. To examine the relationship between the risk of paediatric OSA and craniofacial and /or oropharyngeal characteristics (Mallampati classification, Brodsky's tonsillar grading, and occlusion type). To evaluate sleep history, habits such as snoring, daytime sleepiness, and observe for behavioural problems. To encourage a multidisciplinary approach to care by highlighting the role that dentists play in the early screening, diagnosis, and referral of children with suspected OSA. MATERIALS AND METHODS This cross-sectional study aimed to test the accuracy of reporting paediatric obstructive sleep apnoea (OSA) and associated tooth problems through the use of a standardised questionnaire along with clinical evaluation in Sharad Pawar Dental College, Sawangi, Wardha. The validated questionnaire consisted of closed-ended questions and was distributed to the parents who provided their informed consent in advance. The survey conducted at the department level was anonymous. The research group consisted of 60 children aged 6–12 years of age, 30 boys, and 30 girls. The information was collected after the survey in systematic manners: it was counted, tabulated, and analysed. Clinical examinations were done under adequate light and sterile equipment, where a qualified dental practitioner examined the patient using sterile tools, including cotton pellets, a mouth mirror, a probe, and an explorer. The processes were fully outlined to the participants during the pre-assessment in order to ensure that they participated and were comfortable. The patients were requested to open their mouths wide to examine the soft palate. The soft palate was also analysed and determined by the Mallampati classification [ 2 , 5 , 8 ] . The Mallampati scale is as follows: Class 1: Soft palate: full visualisation. Class 2: Uvula fully visualised. Class 3: Only the base of the uvula is visualised. Class 4: no Soft palate visible [ 4 , 6 – 8 ] . Tonsils were assessed with the help of a tongue depressor in case of necessity and were evaluated by the Brodsky score [ 2 , 6 – 8 ] . The classification was provided by Brodsky as follows: Grade 0: Tonsils restricted to the tonsillar fossa. Grade 1: Tonsils take up to 25 percent of the distance between the anterior pillars of the oropharynx. Grade 2: Tonsils taking 25–50% of the distance between the anterior pillars. Grade 3: Tonsils taking 50–75% between the anterior pillars. Grade 4: Tonsils take up 75–100% of the area amid anterior pillars [ 9 , 10 ] . The occlusion was evaluated and rated in terms of the classification of malocclusion by Angle as follows: Class I: In the case when the upper and lower molars are in normal relationship, it is referred to as neuro-occlusion. Class II: In an instance where the lower molar is found behind the upper molar, the latter is referred to as disto-occlusion. Class III: In the event of the lower molar being in the advancement of the upper molar, this phenomenon is called the mesio-occlusion [ 7 – 10 ] . The evaluation of caries in the mouth was performed using the classification of G.V. Black. Table 1 and Table 2 add other parameters, such as snoring, difficulty in concentration and daytime sleepiness, which were measured using the parameters of YES and NO by means of a questionnaire. Other parameters were also measured, like TMD (temporomandibular disorders), facial profile, and bruxism. [ 8 , 11 , 12 ] . Table 1 Clinical features questionnaire Parameters YES/NO Total results out of 60 P- value Respiratory Diseases Tonsillitis Yes 2 3.3 No 58 96.6 Asthma Yes 5 8.33 No 55 91.6 Prolonged duration of cough and cold Yes 2 3.3 No 58 96.6 Snoring Yes 38 63.3 No 22 36.6 Altered behaviour / Behavioural symptoms Yes 43 71.6 No 17 28.3 Daytime sleepiness Yes 45 75 No 15 25 Table 2 Clinical Evaluation Intraoral Examination Total results out of 60 P- value Mallampati I 40 66.6 II 17 28.3 III 3 5 IV 0 0 Occlusion Class I 39 65 Class II 21 35 Class III 0 0 Crowding Yes 9 15 No 51 85 Open bite Yes 14 23.3 No 46 76.6 Halitosis Yes 37 61.6 No 23 38.3 Dental caries Yes 46 76.6 No 14 23.3 Poor oral hygiene (Stains and Calculus) Yes 53 88.3 No 7 11.6 QUESTIONNAIRE VALIDATION: The questionnaire to be used in the given study was based on the Paediatric Sleep Questionnaire (PSQ), which has been developed and tested by Chervin and his peers to detect sleep-disordered breathing and obstructive sleep apnoea (OSA) in children. It has been shown to have good diagnostic accuracy when compared to polysomnography, with the sensitivity and specificity of the PSQ being reported to be between 85 and 87 per cent and 87 percent respectively. The original PSQ measures the key clinical areas associated with paediatric OSA, such as habitual snoring, sleepiness, behavioural disturbances and attention difficulties. In the current research, a few items of the closed-ended type related to these areas have been chosen and fitted to be simple and clear enough so that parents can comprehend them and do not question the content validity of the given questionnaire. The modified questionnaire was given to parents or guardians after informed consent and served as a screening instrument in the identification of children in danger of sleep-disordered breathing in a dental clinical facility. ELIGIBILITY CRITERIA: This study is based on the following eligibility criteria: - INCLUSION CRITERIA- Children with dental anomalies Children with Breathing disorders Children with Tonsillitis EXCLUSION CRITERIA- Patients suffering from any severe systemic problems. Uncooperative children Parents who refused to participate in the study STATISTICAL ANALYSIS: The data were summarised using descriptive statistics, and the frequencies and percentages of categorical variables were used. The Chi-square test was employed to compare the relations between the OSA-related symptoms (snoring, daytime sleepiness and behavioural changes) and the dental-related factors, including the dental caries, oral hygiene status, halitosis, malocclusion, and tonsillar hypertrophy. In cases where the anticipated number of cells was below five, Fisher's exact test was used. The correlation between ordinal variables, Mallampati classification, tonsillar grading of Brodsky and the indicators of risk associated with OSA, was assessed using the rank correlation coefficient (r) of Spearman. A p-value below 0.05 was thought to be statistically significant, and all the analyses were made at a confidence interval of 95. The association between obstructive sleep apnoea (OSA) and dental-related illnesses was evaluated by analysing data from 60 children, 30 of whom were male and 30 of whom were female, aged 6 to 12. The distribution of clinical and questionnaire-based factors was derived using descriptive statistics. Frequencies and percentages were used to depict the prevalence of categorical variables, and descriptive analysis was used to look at the relationships between OSA-related symptoms and dental results. Of the research participants, 38 children (63.3%) reported snoring, and 45 children (75%) reported being sleepy throughout the day. Changes in behaviour, including irritation and decreased focus, were seen in 43 children (71.6%). These measures were the main clinical indications of paediatric OSA and strongly suggested the presence of underlying sleep-disordered breathing. In terms of dental-related conditions, 37 children (61.6%) had halitosis, while 46 children (76.6%) had dental caries. The most common dental condition in the research group was poor oral hygiene, which was evident in 53 children (88.3%) and was characterised by calculus and visible stains. Multiple types of malocclusions were found: Angle's Class I in 65% of instances, Class II in 35% of cases, and Class III in 0% of cases. This suggests that airway dynamics may impact or be influenced by occlusal differences. According to the Mallampati classification, 66.6% of the children were classified as Class I, 28.3% as Class II, 5% as Class III and 0% as Class IV, based on the evaluation of oropharyngeal characteristics, which indicates impaired airway visualisation. Similarly, 53.3% of children showed Grade 3–4 tonsillar hypertrophy, as determined by Brodsky's score, indicating an anatomical propensity for airway blockage. When combined, the descriptive analysis shows that children who had positive symptoms of OSA also had a greater burden of oral health issues, specifically malocclusion, dental caries, and poor oral hygiene. The idea that paediatric OSA and oral health issues have reciprocal and clinically significant connections is supported by the overlapping distribution of dental and airway-related factors. CORRELATION ANALYSIS: The relationship between the paediatric OSA-related symptoms and various dental-related conditions was found to be significant. Children with symptoms indicative of OSA, including habitual snoring, excessive daytime sleepiness and behavioural changes, had a greater occurrence of dental caries, poor oral health, halitosis and malocclusion. The correlation analysis revealed a positive correlation between increased Mallampati classes and intensified tonsillar hypertrophy, which meant that airway patency was compromised. Also, children who had higher risks of OSA had more bruxism and temporomandibular disorders, which indicates that there is a functional dependence between airway obstruction and orofacial muscular activity. The results support the idea of a mutual relationship between airway obstruction and oral health conditions in children. RESULTS A total of 60 patients were screened and evaluated to study the correlation between obstructive sleep apnoea and dental-related disorders. A total of 60 participants were evaluated in the study. The parameters measured among them are presented in Tables 1 and 2 . Snoring was found to be present in 63.3% of the children, Alterations in behaviour were found in 71.6% of the children, and Daytime sleepiness was found in 75% of the children. These three parameters were found to be of great significance in association with OSA. Other corresponding factors found were caries in about 76.6% children, halitosis in 61.6% and poor oral hygiene that included the presence of stains and calculus in about 88.3% children. As a result, these variables may be more likely to be linked to the likelihood of having OSA, which is equivalent to diseases connected to the teeth. All of the other elements still play a significant role, even though they did not significantly contribute to the proof. DISCUSSION This study investigated the link between a number of dental disorders and obstructive sleep apnoea (OSA), as well as the variables that influence this relationship [ 1 , 13 , 14 ] . Beyond its dental health consequences, OSA is a complex sleep-related respiratory illness that is typically associated with Metabolic syndrome, Cardiovascular diseases, and Hypertension. Both REM and non-REM sleep phases are associated with recurring bouts of partial or total upper airway blockage, which are the pathophysiological hallmark of OSA [ 6 , 15 ] . These obstructive events interfere with the usual architecture of sleep, leading to irregular breathing patterns, fragmented sleep, and frequent arousals, all of which impair the quality of sleep overall [ 6 , 7 , 15 ] . The current study contributes to the expanding body of research that emphasises the reciprocal relationship between airway obstruction and dental symptoms by highlighting the strong correlation between juvenile OSA and oral health issues [ 16 ] . Children with OSA are found to have many dental abnormalities such as Open bites(it is a malocclusion where the upper and lower teeth fail to meet when the mouth is closed), Dental caries(tooth decay or cavities due to dissolution of inorganic material and destruction of organic substances of teeth), crowding(dental misalignment resulting from insufficient space for the teeth), Dry mouth (xerostomia), Poor oral hygiene(stains and calculus), and Halitosis(bad breath) [ 1 – 3 , 16 ] . These symptoms are not found in isolation, but rather accompanied by snoring, altered behaviour, difficulty in organizing activities and duties, trouble concentrating, and daytime sleepiness, depressive symptoms, breathing interruptions during sleep such as apnoea( defined as complete obstruction of airflow for at least 10 sec- with a concomitant 2 to 4% drop in arterial oxygen saturation) and hypo-apnoea (defined as reduction in airflow to at least 30–40% with a drop of oxygen saturation), headaches, and cognitive dysfunction [ 6 , 16 , 17 ] . OSA varies in children and adults, with key differences in symptom presentation. Children are more likely to exhibit behavioural problems, such as difficulty concentrating, bedwetting, and hyperactivity, whereas adults often experience daytime sleepiness. Unrecognised disease and delayed care in such children can further exacerbate their condition [ 1 , 4 , 18 ] . From a dental perspective, delayed oral care can exacerbate dental problems, leading to pain, discomfort, and even irreversible damage [ 17 – 19 ] . Therefore, the job of a dentist is crucial in diagnosing and treating these children. A dental professional's understanding of obstructive sleep apnoea (OSA) can help them maintain their oral health and aid in early diagnosis, which will result in an effective treatment plan. Patho-physiologically, mouth breathing brought on by airway blockage can result in xerostomia, altered oral pH, and decreased salivary buffering ability, all of which raise the risk of dental cavities and halitosis [ 2 , 12 , 19 ] . In a similar vein, children with OSA may be more susceptible to malocclusion, open bites, and modifications in facial development patterns due to altered orofacial muscle activation. This association emphasises how important dentists are in both restoring oral function and identifying symptoms of underlying systemic illness [ 20 ] . OSA has a substantial impact on an individual's oral health in addition to their general health and quality of life. Predisposing factors that are found in relation to OSA are obesity, which is one of the major contributing factors, enlarged uvula, tonsillar hypertrophy, enlarged adenoids, deviated nasal septum (DNS), high arched palate, increased anterior facial height, and inferiorly displaced hyoid bone [ 16 , 19 ] . In obese patients, the inspiratory strength of the diaphragm decreases, which causes a reduction in the mechanical lung capacity [ 4 , 5 , 20 ] . Macroglossia is one of the many other factors that can contribute to difficulty in breathing, as due to its large volume, the tongue collapses and blocks the posterior area that includes the uvula and tonsillar pillars, causing respiratory distress [ 21 ] . Another contributing factor is the presence of any tumours that could cause a pathological blockage of the airway and cause breathing difficulties [ 21 , 22 ] . Various syndromes, as mentioned above, can also be responsible for the same. A thorough history that includes a patient profile, any known allergies, recent weight changes, other habits, the patient's typical sleeping position, any ongoing medications, knowledge of their sleep patterns, and a clinical examination can be used to diagnose OSA. These insights can help ensure that a proper diagnosis is made and a suitable and better constructive treatment plan for the patient can be made [ 1 , 9 , 21 , 22 ] . Other methods to identify it are polysomnography (PSG), which requires the patient to stay overnight in a sleep facility, and can be a standard method to diagnose OSA [ 23 ] . The severity of OSA can be classified according to the AHI (apnoea-hypoapnoea index) into three major categories: 1. Mild OSA (5 to 15 events per h) 2. Moderate OSA (15 to 30 events per h) 3. Severe OSA (more than 30 events per h) [ 23 ] . In the present study, patients demonstrated an increased prevalence of Mallampati class 1 (66.6%) and Angle’s class I malocclusion (65%). Even though Angle’s class II malocclusion is seen to be a risk factor for OSA, the present study did not find it to be a significant risk factor; a significant association of open bite, crowding, or facial profile was seen. Tonsillitis, even though it is an important contributing factor in the diagnosis of OSA, was not found to be a significant factor, as only 3.3% of the children were found to have tonsillitis. Consistent results were seen with an increase in the frequency of attrition (dental tooth wear). Due to poor oral hygiene, halitosis and xerostomia were also found to be significantly associated with OSA [ 8 , 17 , 19 – 22 ] . As mentioned above, attrition was seen in more than half of the patients, which caused repeated strain on the TMJ, leading to TMDs (temporomandibular disorders). Another major finding observed during the examination of the patients was the higher prevalence of periodontitis among those with OSA [ 5 , 11 , 23 ] . Based on the findings, an interdisciplinary approach is necessary in managing patients with OSA to ensure comprehensive and qualitative patient care. These findings highlight the necessity of regular OSA screening in paediatric dentistry from a clinical standpoint. Basic chairside assessments, including tonsillar grading, Mallampati classification, and occlusal assessment, can assist in identifying children who are at risk and facilitate prompt referral to sleep medicine specialists. This is especially important in low-resource environments where the gold standard for diagnosing OSA, polysomnography, might not be easily accessible. Therefore, the first line of defence in identifying paediatric OSA might be dentists [ 24 ] . Patients with OSA should be referred to dental professionals and hence be instructed to maintain regular periodic professional examinations in addition to active treatments. Paediatric dentists play an essential role. Paediatric dentists have a therapeutic function in addition to screening. In developing youngsters, interventions include mandibular advancement devices, rapid maxillary expansion (RME) for narrow palates, and habit-breaking appliances for mouth breathing, which can improve airway dimensions and reduce OSA symptoms [ 13 , 20 , 24 ] . Additionally, paediatric dentists may inform parents on how sleep-disordered breathing affects a child's oral and overall health, highlighting the value of routine dental checkups as a component of an interdisciplinary treatment approach. The long-term neurocognitive, behavioural, and cardiometabolic effects of untreated paediatric OSA may be avoided with such cooperative and collaborative measures [ 25 ] . Thus, paediatric dentists act not only as oral healthcare providers but also as gatekeepers in the multidisciplinary management of paediatric OSA, bridging the gap between dentistry, sleep medicine, and otolaryngology [ 25 , 26 ] . CONCLUSION The results of this study demonstrate a strong correlation between dental-related conditions and obstructive sleep apnoea (OSA), highlighting the reciprocal association between oral health and airway obstruction. Conditions that may impact airway patency, including bruxism, temporomandibular disorders, periodontal disease, and changes in the morphology of the craniofacial region, were more common in patients with OSA. These findings highlight how important it is for dentists to actively participate in the early diagnosis and multidisciplinary treatment of OSA. Through coordinated care between dental experts and sleep medicine practitioners, systematic screening for sleep-disordered breathing within dental practices may improve treatment results in addition to facilitating prompt diagnosis. The paper also identifies the importance of the use of occlusal examination and craniofacial assessment as diagnostic methods in identifying the risk of OSA. Oral appliance treatment, orthodontic therapies, and maxillofacial techniques have potential in the treatment of OSA symptoms and other associated dental problems, even though they require larger, controlled studies to establish their effectiveness. The overall consequences of untreated sleep apnoea on the cardiovascular and metabolic systems may be significantly reduced with the incorporation of dental perspectives into the OSA therapy. From the perspective of public health, oral symptoms of OSA are less well-known to both dentists, patients and medical professionals and thus by raising awareness about this symptom, the disease can be easily diagnosed at an early age and prevented before worsening. Future studies must consider longitudinal study designs, high-resolution imaging and biomarker studies to elucidate the causative mechanisms and enhance the evidence of interdisciplinary treatment approaches. By connecting dental medicine and sleep medicine together, healthcare systems will be able to shift to a more comprehensive and preventative delivery system that will not only improve the health of the airways, but also the general health and quality of life. Declarations Ethics Approval and Consent to Participate The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2013 revision) and in compliance with the guidelines of the Institutional Ethics Committee of Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha (Approval No: DMIHER(DU)/IEC/2024/261). Written informed consent was obtained from the parents or legal guardians of all participating children before their enrollment in the study. Consent for Publication Informed consent to publication was obtained in writing by the parent(s) or legal guardian(s) of all the children participating in the study before their enrolment into the study. The parent(s)/guardian(s) gave consent to the use of anonymised data for analysis and publication in the research on behalf of their child (ren). They were informed of the reason behind the study and the process that the study would entail. They were assured that no information that would be used to identify the participants personally would be published. Competing Interests The authors declare that they have no competing interests. Funding The authors received no specific funding for this work. Author Contribution The first author conceived and designed the study, performed a literature review, developed methodology, collected and analysed data and drafted the manuscript. All authors read and approved the final manuscript. The second author provided critical input during data interpretation and manuscript revision, and supervised the project throughout. The third author guided the research and critically reviewed the manuscript, while the fourth author assisted with statistical analysis and manuscript drafting. Acknowledgements The authors would like to thank the children and their parents for their cooperation and participation in the study. The authors also acknowledge the support of Sharad Pawar Dental College and Hospital, Wardha, for providing the necessary facilities to conduct this research. References Heath DS, El-Hakim H, Al-Rahji Y, Eksteen E, Uwiera TC, Isaac A, Castro-Codesal M, Gerdung C, Maclean J, Mandhane PJ. Development of a pediatric obstructive sleep apnea triage algorithm. J Otolaryngol Head Neck Surg. 2021;50(1):48. 10.1186/s40463-021-00528-8 . Tamasas B, Nelson T, Chen M. Oral health and oral health-related quality of life in children with obstructive sleep apnea. J Clin Sleep Med. 2019;15(3):445–52. 10.5664/jcsm.7672 . Moin Anwer HM, Albagieh HN, Kalladka M, Chiang HK, Malik S, McLaren SW, Khan J. The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea. Saudi Dent J. 2021;33(7):424–33. 10.1016/j.sdentj.2021.02.001 . Huang YS, Guilleminault C. Pediatric obstructive sleep apnea: where do we stand? Adv Otorhinolaryngol. 2017;80:136–44. 10.1159/00047088555 . Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429–34. 10.1007/BF03011357 . Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989;36(6):1551–69. 10.1016/S0031-3955(16)36806-7 . Alrejaye NS, Al-Jahdali H. Dentists’ role in obstructive sleep apnea: A more comprehensive review. Sleep Epidemiol. 2024;4:100073. 10.1016/j.sleepe.2024.100073 . Quan SF, Schmidt-Nowara W. The role of dentists in the diagnosis and treatment of obstructive sleep apnea: consensus and controversy. J Clin Sleep Med. 2017;13(10):1117–9. 10.5664/jcsm.6748 . Lo Giudice A, La Rosa S, Ronsivalle V, Isola G, Cicciù M, Alessandri-Bonetti G, Leonardi R. Indications for dental specialists for treating obstructive sleep apnea with mandibular advancement devices: a narrative review. Int J Dent. 2024;2024:1007237. 10.1155/2024/1007237 . Berggren K, Broström A, Firestone A, Wright B, Josefsson E, Lindmark U. Oral health problems linked to obstructive sleep apnea are not always recognized within dental care—As described by dental professionals. Clin Exp Dent Res. 2022;8(1):84–95. 10.1002/cre2.517 . Parmenter D, Millar BJ. How can general dental practitioners help in the management of sleep apnoea? Br Dent J. 2023;234(7):505–9. 10.1038/s41415-023-5684-1 . Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath. 2007;11(1):1–22. 10.1007/s11325-006-0084-8 . Schmidt-Nowara W. A review of sleep disorders. The history and diagnosis of sleep disorders related to the dentist. Dent Clin North Am. 2001;45(4):631–42. Ghosh P, Janakiram C, Nk SV, Vv KS. Oral appliance therapy for the management of obstructive sleep apnea in adults: an umbrella review. JBI Evid Synth. 2025;23(5):876–919. 10.11124/JBIES-23-00539 . Barsh LI. Dentistry's role in the recognition and treatment of sleep-breathing disorders: the need for cooperation with the medical community. J Calif Dent Assoc. 1998;26(8):591–8. Padma A, Ramakrishnan N, Narayanan V. Management of obstructive sleep apnea: a dental perspective. Indian J Dent Res. 2007;18(4):201–9. 10.4103/0970-9290.35833 . Maniaci A, Lavalle S, Anzalone R, Lo Giudice A, Cocuzza S, Parisi FM, Torrisi F, Iannella G, Sireci F, Fadda G, Lentini M, Masiello E, La Via L. Oral health implications of obstructive sleep apnea: a literature review. Biomedicines. 2024;12(7):1382. 10.3390/biomedicines12071382 . Bian H, Smith CL. Development of a questionnaire to assess dentists' knowledge, opinion, education resources, physician cooperation, and clinical practice regarding obstructive sleep apnea (OSAQ-D). Sleep Breath. 2006;10(2):76–82. 10.1007/s11325-005-0045-7 . Lavanya R, Gandhi Babu DB, Chavva S, Boringi M, Waghray S, Yeladandi M. The role of oral physicians in predicting the risk of obstructive sleep apnea: a case-control study. Imaging Sci Dent. 2016;46(3):167–71. 10.5624/isd.2016.46.3.167 . Alharbi LN, Alsaikhan MA, Al-Haj Ali SN, Farah RI. Pediatric obstructive sleep apnea: knowledge and attitudes of medical and dental students and fresh graduates from Saudi Arabia. Child (Basel). 2021;8(9):768. 10.3390/children8090768 . Alzahrani MM, Alghamdi AA, Alghamdi SA, Alotaibi RK. Knowledge and attitude of dentists towards obstructive sleep apnea. Int Dent J. 2022;72(3):315–21. 10.1016/j.identj.2021.05.004 . Ashraf A, Menon I, Gupta R, Arora V, Ahsan I, Das D. Oral findings as predictors of obstructive sleep apnea—A case-control study. J Family Med Prim Care. 2022;11(9):5263–7. 10.4103/jfmpc.jfmpc_582_21 . Cioboata R, Balteanu MA, Mitroi DM, Catana OM, Tieranu M-L, Vlasceanu SG, Tieranu EN, Biciusca V, Mirea AA. Interdisciplinary perspectives on dentistry and sleep medicine: a narrative review of sleep apnea and oral health. J Clin Med. 2025;14(15):5603. 10.3390/jcm14155603 . Woo K, Lee J, Jung C-E, Park J, Choy Y. The association between obstructive sleep apnea and oral function, using the Korea National Health and Nutrition Examination Survey data. Healthc (Basel). 2025;13(11):1323. 10.3390/healthcare13111323 . Tamkin J. Impact of airway dysfunction on dental health. Bioinformation. 2020;16(1):26–9. 10.6026/97320630016026 . Dave RD. Sleep-disordered breathing and dental sleep medicine: implications for oral health and overall well-being. Arch Dent Res. 2023;13(1):34–40. 10.18231/j.adr.2023.007 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8607189","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591140706,"identity":"558f4b6b-c200-4da5-9186-2e71f3887981","order_by":0,"name":"Himanshi Patel","email":"data:image/png;base64,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","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Himanshi","middleName":"","lastName":"Patel","suffix":""},{"id":591140707,"identity":"47a448b7-0401-4acc-9fe2-1d21d1f82d40","order_by":1,"name":"Dr Rashi Dubey","email":"","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Dr","firstName":"Rashi","middleName":"","lastName":"Dubey","suffix":""},{"id":591140710,"identity":"6d3d5a4c-a764-4b0f-a52e-de958f72d7a3","order_by":2,"name":"Dr Nilima Thosar","email":"","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Dr","firstName":"Nilima","middleName":"","lastName":"Thosar","suffix":""},{"id":591140714,"identity":"b2fe8831-a481-41fd-b81d-c9ab14cf2558","order_by":3,"name":"Dr Neha Pankey","email":"","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Dr","firstName":"Neha","middleName":"","lastName":"Pankey","suffix":""},{"id":591140719,"identity":"fdd9989a-5c2e-458c-9895-2313763e769b","order_by":4,"name":"Romit Kharbade","email":"","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Romit","middleName":"","lastName":"Kharbade","suffix":""}],"badges":[],"createdAt":"2026-01-15 05:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8607189/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8607189/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103049477,"identity":"bedd404e-e7f9-4d32-855b-767b14fa25c4","added_by":"auto","created_at":"2026-02-20 07:41:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":720010,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8607189/v1/2cbecaf1-66c1-4365-a965-5438cdf8e8bd.pdf"},{"id":102829190,"identity":"c43b74c0-48b1-4b2d-a01a-8c875cde7628","added_by":"auto","created_at":"2026-02-17 09:32:19","extension":"jpg","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":184060,"visible":true,"origin":"","legend":"","description":"","filename":"questionnaire.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8607189/v1/638593ebe12f38e2d0f5ae2d.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Sleep-Related Breathing Disorders in Children: Exploring Links Between Obstructive Sleep Apnea and Dental Disorders – A Questionnaire-Based Cross-Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eObstructive sleep apnoea (OSA) and persistent snoring are the two main respiratory disorders that fall under the umbrella of sleep-disordered breathing (SDB). The incidence of OSA in children is thought to be between 1% and 5%. Still, since its clinical symptoms can be confused with those of other behavioural and developmental issues, it is often underdiagnosed. The pathophysiological definition of OSA is characterised by recurrent episodes of partial or whole upper airway collapse during sleep, which can cause hypercapnia, intermittent hypoxia, and disturbance of the regular sleep architecture. Apnoea (airflow halt) or hypopnea (airflow reduction) are the symptoms of OSA \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Long-term symptoms of OSA have been linked to behavioural issues, emotional dysregulation, learning disabilities, and metabolic and cardiovascular issues \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The longer the duration of sleep-related breathing problems, the more significant the associated symptoms are. Children are in the growing stages and thus any changes in their mental and physical states associated with SDB could bring about significant changes in a child\u0026rsquo;s life and may affect their social potential \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Oral health is an essential component of overall systemic health, and children with OSA have increased risks of malocclusions, periodontal problems, and caries. Children with OSA require a dental professional to maintain and treat them with quality care since poor oral health impairs a person's capacity to eat, sleep, and function \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. There are many syndromes and genetic disorders that are also associated with OSA, such as cleft palate, cerebral palsy, Turner\u0026rsquo;s syndrome, and Pierre Robin syndrome \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Paediatric OSA is characterised by disturbed nocturnal sleep, snoring, difficulty focusing at school, daytime sleepiness, behavioural problems, and trouble organising duties and activities \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. These correlations suggest a reciprocal relationship: OSA itself may exacerbate oral health problems, while craniofacial and dental abnormalities may increase a child's susceptibility to airway obstruction. This overlap emphasises the importance of\u003c/p\u003e \u003cp\u003eorthodontists and paediatric dentists in the early detection and treatment of paediatric OSA \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This background informed the design of the current study, which used a validated questionnaire-based survey in conjunction with a clinical dental examination to evaluate the relationship between paediatric OSA and dental-related disorders in a cohort of children aged 6\u0026ndash;12. This study supports the evidence foundation for the importance of Dentistry in Paediatric OSA screening and to promote early interdisciplinary care options by assessing important factors such as airway obstruction, tonsillar size, malocclusion, dental hygiene, and caries status \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSTUDY OBJECTIVES-\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEmploying a structured questionnaire, determine the prevalence of paediatric obstructive sleep apnoea (OSA) and sleep-related respiratory problems in children aged 6\u0026ndash;12.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess the relationship between common dental diseases such as halitosis, bruxism, dental caries, malocclusion, poor oral hygiene, and temporomandibular disorders (TMD) and paediatric OSA.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo examine the relationship between the risk of paediatric OSA and craniofacial and /or oropharyngeal characteristics (Mallampati classification, Brodsky's tonsillar grading, and occlusion type).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo evaluate sleep history, habits such as snoring, daytime sleepiness, and observe for behavioural problems.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo encourage a multidisciplinary approach to care by highlighting the role that dentists play in the early screening, diagnosis, and referral of children with suspected OSA.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis cross-sectional study aimed to test the accuracy of reporting paediatric obstructive sleep apnoea (OSA) and associated tooth problems through the use of a standardised questionnaire along with clinical evaluation in Sharad Pawar Dental College, Sawangi, Wardha. The validated questionnaire consisted of closed-ended questions and was distributed to the parents who provided their informed consent in advance. The survey conducted at the department level was anonymous. The research group consisted of 60 children aged 6\u0026ndash;12 years of age, 30 boys, and 30 girls. The information was collected after the survey in systematic manners: it was counted, tabulated, and analysed. Clinical examinations were done under adequate light and sterile equipment, where a qualified dental practitioner examined the patient using sterile tools, including cotton pellets, a mouth mirror, a probe, and an explorer. The processes were fully outlined to the participants during the pre-assessment in order to ensure that they participated and were comfortable.\u003c/p\u003e \u003cp\u003eThe patients were requested to open their mouths wide to examine the soft palate. The soft palate was also analysed and determined by the Mallampati classification \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. The Mallampati scale is as follows:\u003c/p\u003e \u003cp\u003eClass 1: Soft palate: full visualisation.\u003c/p\u003e \u003cp\u003eClass 2: Uvula fully visualised.\u003c/p\u003e \u003cp\u003eClass 3: Only the base of the uvula is visualised.\u003c/p\u003e \u003cp\u003eClass 4: no Soft palate visible \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTonsils were assessed with the help of a tongue depressor in case of necessity and were evaluated by the Brodsky score \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. The classification was provided by Brodsky as follows:\u003c/p\u003e \u003cp\u003eGrade 0: Tonsils restricted to the tonsillar fossa.\u003c/p\u003e \u003cp\u003eGrade 1: Tonsils take up to 25 percent of the distance between the anterior pillars of the oropharynx.\u003c/p\u003e \u003cp\u003eGrade 2: Tonsils taking 25\u0026ndash;50% of the distance between the anterior pillars.\u003c/p\u003e \u003cp\u003eGrade 3: Tonsils taking 50\u0026ndash;75% between the anterior pillars.\u003c/p\u003e \u003cp\u003eGrade 4: Tonsils take up 75\u0026ndash;100% of the area amid anterior pillars \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe occlusion was evaluated and rated in terms of the classification of malocclusion by Angle as follows:\u003c/p\u003e \u003cp\u003eClass I: In the case when the upper and lower molars are in normal relationship, it is referred to as neuro-occlusion.\u003c/p\u003e \u003cp\u003eClass II: In an instance where the lower molar is found behind the upper molar, the latter is referred to as disto-occlusion.\u003c/p\u003e \u003cp\u003eClass III: In the event of the lower molar being in the advancement of the upper molar, this phenomenon is called the mesio-occlusion \u003csup\u003e[\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe evaluation of caries in the mouth was performed using the classification of G.V. Black. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e add other parameters, such as snoring, difficulty in concentration and daytime sleepiness, which were measured using the parameters of YES and NO by means of a questionnaire. Other parameters were also measured, like TMD (temporomandibular disorders), facial profile, and bruxism. \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical features questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES/NO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal results out of 60\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP- value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eRespiratory Diseases\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTonsillitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProlonged duration of cough and cold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSnoring\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAltered behaviour / Behavioural symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDaytime sleepiness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Evaluation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntraoral Examination\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal results out of 60\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP- value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMallampati\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOcclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCrowding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eOpen bite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHalitosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDental caries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePoor oral hygiene (Stains and Calculus)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eQUESTIONNAIRE VALIDATION:\u003c/h2\u003e \u003cp\u003eThe questionnaire to be used in the given study was based on the Paediatric Sleep Questionnaire (PSQ), which has been developed and tested by Chervin and his peers to detect sleep-disordered breathing and obstructive sleep apnoea (OSA) in children. It has been shown to have good diagnostic accuracy when compared to polysomnography, with the sensitivity and specificity of the PSQ being reported to be between 85 and 87 per cent and 87 percent respectively. The original PSQ measures the key clinical areas associated with paediatric OSA, such as habitual snoring, sleepiness, behavioural disturbances and attention difficulties. In the current research, a few items of the closed-ended type related to these areas have been chosen and fitted to be simple and clear enough so that parents can comprehend them and do not question the content validity of the given questionnaire. The modified questionnaire was given to parents or guardians after informed consent and served as a screening instrument in the identification of children in danger of sleep-disordered breathing in a dental clinical facility.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eELIGIBILITY CRITERIA:\u003c/h3\u003e\n\u003cp\u003eThis study is based on the following eligibility criteria: -\u003c/p\u003e\n\u003ch3\u003eINCLUSION CRITERIA-\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eChildren with dental anomalies\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eChildren with Breathing disorders\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eChildren with Tonsillitis\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eEXCLUSION CRITERIA-\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePatients suffering from any severe systemic problems.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eUncooperative children\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e Parents who refused to participate in the study\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSTATISTICAL ANALYSIS:\u003c/h2\u003e \u003cp\u003eThe data were summarised using descriptive statistics, and the frequencies and percentages of categorical variables were used.\u003c/p\u003e \u003cp\u003eThe Chi-square test was employed to compare the relations between the OSA-related symptoms (snoring, daytime sleepiness and behavioural changes) and the dental-related factors, including the dental caries, oral hygiene status, halitosis, malocclusion, and tonsillar hypertrophy. In cases where the anticipated number of cells was below five, Fisher's exact test was used. The correlation between ordinal variables, Mallampati classification, tonsillar grading of Brodsky and the indicators of risk associated with OSA, was assessed using the rank correlation coefficient (r) of Spearman. A p-value below 0.05 was thought to be statistically significant, and all the analyses were made at a confidence interval of 95. The association between obstructive sleep apnoea (OSA) and dental-related illnesses was evaluated by analysing data from 60 children, 30 of whom were male and 30 of whom were female, aged 6 to 12. The distribution of clinical and questionnaire-based factors was derived using descriptive statistics. Frequencies and percentages were used to depict the prevalence of categorical variables, and descriptive analysis was used to look at the relationships between OSA-related symptoms and dental results. Of the research participants, 38 children (63.3%) reported snoring, and 45 children (75%) reported being sleepy throughout the day. Changes in behaviour, including irritation and decreased focus, were seen in 43 children (71.6%). These measures were the main clinical indications of paediatric OSA and strongly suggested the presence of underlying sleep-disordered breathing.\u003c/p\u003e \u003cp\u003eIn terms of dental-related conditions, 37 children (61.6%) had halitosis, while 46 children (76.6%) had dental caries. The most common dental condition in the research group was poor oral hygiene, which was evident in 53 children (88.3%) and was characterised by calculus and visible stains. Multiple types of malocclusions were found: Angle's Class I in 65% of instances, Class II in 35% of cases, and Class III in 0% of cases. This suggests that airway dynamics may impact or be influenced by occlusal differences.\u003c/p\u003e \u003cp\u003eAccording to the Mallampati classification, 66.6% of the children were classified as Class I, 28.3% as Class II, 5% as Class III and 0% as Class IV, based on the evaluation of oropharyngeal characteristics, which indicates impaired airway visualisation. Similarly, 53.3% of children showed Grade 3\u0026ndash;4 tonsillar hypertrophy, as determined by Brodsky's score, indicating an anatomical propensity for airway blockage.\u003c/p\u003e \u003cp\u003eWhen combined, the descriptive analysis shows that children who had positive symptoms of OSA also had a greater burden of oral health issues, specifically malocclusion, dental caries, and poor oral hygiene. The idea that paediatric OSA and oral health issues have reciprocal and clinically significant connections is supported by the overlapping distribution of dental and airway-related factors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCORRELATION ANALYSIS:\u003c/h2\u003e \u003cp\u003eThe relationship between the paediatric OSA-related symptoms and various dental-related conditions was found to be significant. Children with symptoms indicative of OSA, including habitual snoring, excessive daytime sleepiness and behavioural changes, had a greater occurrence of dental caries, poor oral health, halitosis and malocclusion. The correlation analysis revealed a positive correlation between increased Mallampati classes and intensified tonsillar hypertrophy, which meant that airway patency was compromised. Also, children who had higher risks of OSA had more bruxism and temporomandibular disorders, which indicates that there is a functional dependence between airway obstruction and orofacial muscular activity. The results support the idea of a mutual relationship between airway obstruction and oral health conditions in children.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 60 patients were screened and evaluated to study the correlation between obstructive sleep apnoea and dental-related disorders. A total of 60 participants were evaluated in the study. The parameters measured among them are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Snoring was found to be present in 63.3% of the children, Alterations in behaviour were found in 71.6% of the children, and Daytime sleepiness was found in 75% of the children. These three parameters were found to be of great significance in association with OSA. Other corresponding factors found were caries in about 76.6% children, halitosis in 61.6% and poor oral hygiene that included the presence of stains and calculus in about 88.3% children. As a result, these variables may be more likely to be linked to the likelihood of having OSA, which is equivalent to diseases connected to the teeth. All of the other elements still play a significant role, even though they did not significantly contribute to the proof.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study investigated the link between a number of dental disorders and obstructive sleep apnoea (OSA), as well as the variables that influence this relationship \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Beyond its dental health consequences, OSA is a complex sleep-related respiratory illness that is typically associated with Metabolic syndrome, Cardiovascular diseases, and Hypertension. Both REM and non-REM sleep phases are associated with recurring bouts of partial or total upper airway blockage, which are the pathophysiological hallmark of OSA \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. These obstructive events interfere with the usual architecture of sleep, leading to irregular breathing patterns, fragmented sleep, and frequent arousals, all of which impair the quality of sleep overall \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The current study contributes to the expanding body of research that emphasises the reciprocal relationship between airway obstruction and dental symptoms by highlighting the strong correlation between juvenile OSA and oral health issues \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Children with OSA are found to have many dental abnormalities such as Open bites(it is a malocclusion where the upper and lower teeth fail to meet when the mouth is closed), Dental caries(tooth decay or cavities due to dissolution of inorganic material and destruction of organic substances of teeth), crowding(dental misalignment resulting from insufficient space for the teeth), Dry mouth (xerostomia), Poor oral hygiene(stains and calculus), and Halitosis(bad breath) \u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. These symptoms are not found in isolation, but rather accompanied by snoring, altered behaviour, difficulty in organizing activities and duties, trouble concentrating, and daytime sleepiness, depressive symptoms, breathing interruptions during sleep such as apnoea( defined as complete obstruction of airflow for at least 10 sec- with a concomitant 2 to 4% drop in arterial oxygen saturation) and hypo-apnoea (defined as reduction in airflow to at least 30\u0026ndash;40% with a drop of oxygen saturation), headaches, and cognitive dysfunction \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. OSA varies in children and adults, with key differences in symptom presentation. Children are more likely to exhibit behavioural problems, such as difficulty concentrating, bedwetting, and hyperactivity, whereas adults often experience daytime sleepiness. Unrecognised disease and delayed care in such children can further exacerbate their condition \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. From a dental perspective, delayed oral care can exacerbate dental problems, leading to pain, discomfort, and even irreversible damage \u003csup\u003e[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Therefore, the job of a dentist is crucial in diagnosing and treating these children. A dental professional's understanding of obstructive sleep apnoea (OSA) can help them maintain their oral health and aid in early diagnosis, which will result in an effective treatment plan. Patho-physiologically, mouth breathing brought on by airway blockage can result in xerostomia, altered oral pH, and decreased salivary buffering ability, all of which raise the risk of dental cavities and halitosis \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. In a similar vein, children with OSA may be more susceptible to malocclusion, open bites, and modifications in facial development patterns due to altered orofacial muscle activation. This association emphasises how important dentists are in both restoring oral function and identifying symptoms of underlying systemic illness \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOSA has a substantial impact on an individual's oral health in addition to their general health and quality of life. Predisposing factors that are found in relation to OSA are obesity, which is one of the major contributing factors, enlarged uvula, tonsillar hypertrophy, enlarged adenoids, deviated nasal septum (DNS), high arched palate, increased anterior facial height, and inferiorly displaced hyoid bone \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. In obese patients, the inspiratory strength of the diaphragm decreases, which causes a reduction in the mechanical lung capacity \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Macroglossia is one of the many other factors that can contribute to difficulty in breathing, as due to its large volume, the tongue collapses and blocks the posterior area that includes the uvula and tonsillar pillars, causing respiratory distress \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Another contributing factor is the presence of any tumours that could cause a pathological blockage of the airway and cause breathing difficulties \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Various syndromes, as mentioned above, can also be responsible for the same. A thorough history that includes a patient profile, any known allergies, recent weight changes, other habits, the patient's typical sleeping position, any ongoing medications, knowledge of their sleep patterns, and a clinical examination can be used to diagnose OSA. These insights can help ensure that a proper diagnosis is made and a suitable and better constructive treatment plan for the patient can be made \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Other methods to identify it are polysomnography (PSG), which requires the patient to stay overnight in a sleep facility, and can be a standard method to diagnose OSA \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. The severity of OSA can be classified according to the AHI (apnoea-hypoapnoea index) into three major categories:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e1. Mild OSA (5 to 15 events per h)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e2. Moderate OSA (15 to 30 events per h)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e3. Severe OSA (more than 30 events per h) \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eIn the present study, patients demonstrated an increased prevalence of Mallampati class 1 (66.6%) and Angle\u0026rsquo;s class I malocclusion (65%). Even though Angle\u0026rsquo;s class II malocclusion is seen to be a risk factor for OSA, the present study did not find it to be a significant risk factor; a significant association of open bite, crowding, or facial profile was seen. Tonsillitis, even though it is an important contributing factor in the diagnosis of OSA, was not found to be a significant factor, as only 3.3% of the children were found to have tonsillitis. Consistent results were seen with an increase in the frequency of attrition (dental tooth wear). Due to poor oral hygiene, halitosis and xerostomia were also found to be significantly associated with OSA \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. As mentioned above, attrition was seen in more than half of the patients, which caused repeated strain on the TMJ, leading to TMDs (temporomandibular disorders). Another major finding observed during the examination of the patients was the higher prevalence of periodontitis among those with OSA \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Based on the findings, an interdisciplinary approach is necessary in managing patients with OSA to ensure comprehensive and qualitative patient care. These findings highlight the necessity of regular OSA screening in paediatric dentistry from a clinical standpoint. Basic chairside assessments, including tonsillar grading, Mallampati classification, and occlusal assessment, can assist in identifying children who are at risk and facilitate prompt referral to sleep medicine specialists. This is especially important in low-resource environments where the gold standard for diagnosing OSA, polysomnography, might not be easily accessible. Therefore, the first line of defence in identifying paediatric OSA might be dentists \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePatients with OSA should be referred to dental professionals and hence be instructed to maintain regular periodic professional examinations in addition to active treatments. Paediatric dentists play an essential role. Paediatric dentists have a therapeutic function in addition to screening. In developing youngsters, interventions include mandibular advancement devices, rapid maxillary expansion (RME) for narrow palates, and habit-breaking appliances for mouth breathing, which can improve airway dimensions and reduce OSA symptoms \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Additionally, paediatric dentists may inform parents on how sleep-disordered breathing affects a child's oral and overall health, highlighting the value of routine dental checkups as a component of an interdisciplinary treatment approach. The long-term neurocognitive, behavioural, and cardiometabolic effects of untreated paediatric OSA may be avoided with such cooperative and collaborative measures \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Thus, paediatric dentists act not only as oral healthcare providers but also as gatekeepers in the multidisciplinary management of paediatric OSA, bridging the gap between dentistry, sleep medicine, and otolaryngology \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe results of this study demonstrate a strong correlation between dental-related conditions and obstructive sleep apnoea (OSA), highlighting the reciprocal association between oral health and airway obstruction. Conditions that may impact airway patency, including bruxism, temporomandibular disorders, periodontal disease, and changes in the morphology of the craniofacial region, were more common in patients with OSA. These findings highlight how important it is for dentists to actively participate in the early diagnosis and multidisciplinary treatment of OSA. Through coordinated care between dental experts and sleep medicine practitioners, systematic screening for sleep-disordered breathing within dental practices may improve treatment results in addition to facilitating prompt diagnosis. The paper also identifies the importance of the use of occlusal examination and craniofacial assessment as diagnostic methods in identifying the risk of OSA. Oral appliance treatment, orthodontic therapies, and maxillofacial techniques have potential in the treatment of OSA symptoms and other associated dental problems, even though they require larger, controlled studies to establish their effectiveness. The overall consequences of untreated sleep apnoea on the cardiovascular and metabolic systems may be significantly reduced with the incorporation of dental perspectives into the OSA therapy. From the perspective of public health, oral symptoms of OSA are less well-known to both dentists, patients and medical professionals and thus by raising awareness about this symptom, the disease can be easily diagnosed at an early age and prevented before worsening.\u003c/p\u003e \u003cp\u003eFuture studies must consider longitudinal study designs, high-resolution imaging and biomarker studies to elucidate the causative mechanisms and enhance the evidence of interdisciplinary treatment approaches. By connecting dental medicine and sleep medicine together, healthcare systems will be able to shift to a more comprehensive and preventative delivery system that will not only improve the health of the airways, but also the general health and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e \u003cp\u003e The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2013 revision) and in compliance with the guidelines of the Institutional Ethics Committee of Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha (Approval No: DMIHER(DU)/IEC/2024/261). Written informed consent was obtained from the parents or legal guardians of all participating children before their enrollment in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication\u003c/strong\u003e \u003cp\u003e Informed consent to publication was obtained in writing by the parent(s) or legal guardian(s) of all the children participating in the study before their enrolment into the study. The parent(s)/guardian(s) gave consent to the use of anonymised data for analysis and publication in the research on behalf of their child (ren). They were informed of the reason behind the study and the process that the study would entail. They were assured that no information that would be used to identify the participants personally would be published.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe first author conceived and designed the study, performed a literature review, developed methodology, collected and analysed data and drafted the manuscript. All authors read and approved the final manuscript. The second author provided critical input during data interpretation and manuscript revision, and supervised the project throughout. The third author guided the research and critically reviewed the manuscript, while the fourth author assisted with statistical analysis and manuscript drafting.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to thank the children and their parents for their cooperation and participation in the study. The authors also acknowledge the support of Sharad Pawar Dental College and Hospital, Wardha, for providing the necessary facilities to conduct this research.\u003c/p\u003e "},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHeath DS, El-Hakim H, Al-Rahji Y, Eksteen E, Uwiera TC, Isaac A, Castro-Codesal M, Gerdung C, Maclean J, Mandhane PJ. Development of a pediatric obstructive sleep apnea triage algorithm. J Otolaryngol Head Neck Surg. 2021;50(1):48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40463-021-00528-8\u003c/span\u003e\u003cspan address=\"10.1186/s40463-021-00528-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamasas B, Nelson T, Chen M. Oral health and oral health-related quality of life in children with obstructive sleep apnea. J Clin Sleep Med. 2019;15(3):445\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5664/jcsm.7672\u003c/span\u003e\u003cspan address=\"10.5664/jcsm.7672\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoin Anwer HM, Albagieh HN, Kalladka M, Chiang HK, Malik S, McLaren SW, Khan J. The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea. Saudi Dent J. 2021;33(7):424\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.sdentj.2021.02.001\u003c/span\u003e\u003cspan address=\"10.1016/j.sdentj.2021.02.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang YS, Guilleminault C. Pediatric obstructive sleep apnea: where do we stand? Adv Otorhinolaryngol. 2017;80:136\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/00047088555\u003c/span\u003e\u003cspan address=\"10.1159/00047088555\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/BF03011357\u003c/span\u003e\u003cspan address=\"10.1007/BF03011357\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989;36(6):1551\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0031-3955(16)36806-7\u003c/span\u003e\u003cspan address=\"10.1016/S0031-3955(16)36806-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlrejaye NS, Al-Jahdali H. Dentists\u0026rsquo; role in obstructive sleep apnea: A more comprehensive review. Sleep Epidemiol. 2024;4:100073. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.sleepe.2024.100073\u003c/span\u003e\u003cspan address=\"10.1016/j.sleepe.2024.100073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuan SF, Schmidt-Nowara W. The role of dentists in the diagnosis and treatment of obstructive sleep apnea: consensus and controversy. J Clin Sleep Med. 2017;13(10):1117\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5664/jcsm.6748\u003c/span\u003e\u003cspan address=\"10.5664/jcsm.6748\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo Giudice A, La Rosa S, Ronsivalle V, Isola G, Cicci\u0026ugrave; M, Alessandri-Bonetti G, Leonardi R. Indications for dental specialists for treating obstructive sleep apnea with mandibular advancement devices: a narrative review. Int J Dent. 2024;2024:1007237. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2024/1007237\u003c/span\u003e\u003cspan address=\"10.1155/2024/1007237\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerggren K, Brostr\u0026ouml;m A, Firestone A, Wright B, Josefsson E, Lindmark U. Oral health problems linked to obstructive sleep apnea are not always recognized within dental care\u0026mdash;As described by dental professionals. Clin Exp Dent Res. 2022;8(1):84\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/cre2.517\u003c/span\u003e\u003cspan address=\"10.1002/cre2.517\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParmenter D, Millar BJ. How can general dental practitioners help in the management of sleep apnoea? Br Dent J. 2023;234(7):505\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41415-023-5684-1\u003c/span\u003e\u003cspan address=\"10.1038/s41415-023-5684-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath. 2007;11(1):1\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11325-006-0084-8\u003c/span\u003e\u003cspan address=\"10.1007/s11325-006-0084-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmidt-Nowara W. A review of sleep disorders. The history and diagnosis of sleep disorders related to the dentist. Dent Clin North Am. 2001;45(4):631\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhosh P, Janakiram C, Nk SV, Vv KS. Oral appliance therapy for the management of obstructive sleep apnea in adults: an umbrella review. JBI Evid Synth. 2025;23(5):876\u0026ndash;919. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11124/JBIES-23-00539\u003c/span\u003e\u003cspan address=\"10.11124/JBIES-23-00539\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarsh LI. Dentistry's role in the recognition and treatment of sleep-breathing disorders: the need for cooperation with the medical community. J Calif Dent Assoc. 1998;26(8):591\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePadma A, Ramakrishnan N, Narayanan V. Management of obstructive sleep apnea: a dental perspective. Indian J Dent Res. 2007;18(4):201\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0970-9290.35833\u003c/span\u003e\u003cspan address=\"10.4103/0970-9290.35833\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManiaci A, Lavalle S, Anzalone R, Lo Giudice A, Cocuzza S, Parisi FM, Torrisi F, Iannella G, Sireci F, Fadda G, Lentini M, Masiello E, La Via L. Oral health implications of obstructive sleep apnea: a literature review. Biomedicines. 2024;12(7):1382. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/biomedicines12071382\u003c/span\u003e\u003cspan address=\"10.3390/biomedicines12071382\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBian H, Smith CL. Development of a questionnaire to assess dentists' knowledge, opinion, education resources, physician cooperation, and clinical practice regarding obstructive sleep apnea (OSAQ-D). Sleep Breath. 2006;10(2):76\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11325-005-0045-7\u003c/span\u003e\u003cspan address=\"10.1007/s11325-005-0045-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLavanya R, Gandhi Babu DB, Chavva S, Boringi M, Waghray S, Yeladandi M. The role of oral physicians in predicting the risk of obstructive sleep apnea: a case-control study. Imaging Sci Dent. 2016;46(3):167\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5624/isd.2016.46.3.167\u003c/span\u003e\u003cspan address=\"10.5624/isd.2016.46.3.167\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlharbi LN, Alsaikhan MA, Al-Haj Ali SN, Farah RI. Pediatric obstructive sleep apnea: knowledge and attitudes of medical and dental students and fresh graduates from Saudi Arabia. Child (Basel). 2021;8(9):768. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/children8090768\u003c/span\u003e\u003cspan address=\"10.3390/children8090768\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlzahrani MM, Alghamdi AA, Alghamdi SA, Alotaibi RK. Knowledge and attitude of dentists towards obstructive sleep apnea. Int Dent J. 2022;72(3):315\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.identj.2021.05.004\u003c/span\u003e\u003cspan address=\"10.1016/j.identj.2021.05.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshraf A, Menon I, Gupta R, Arora V, Ahsan I, Das D. Oral findings as predictors of obstructive sleep apnea\u0026mdash;A case-control study. J Family Med Prim Care. 2022;11(9):5263\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jfmpc.jfmpc_582_21\u003c/span\u003e\u003cspan address=\"10.4103/jfmpc.jfmpc_582_21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCioboata R, Balteanu MA, Mitroi DM, Catana OM, Tieranu M-L, Vlasceanu SG, Tieranu EN, Biciusca V, Mirea AA. Interdisciplinary perspectives on dentistry and sleep medicine: a narrative review of sleep apnea and oral health. J Clin Med. 2025;14(15):5603. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm14155603\u003c/span\u003e\u003cspan address=\"10.3390/jcm14155603\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoo K, Lee J, Jung C-E, Park J, Choy Y. The association between obstructive sleep apnea and oral function, using the Korea National Health and Nutrition Examination Survey data. Healthc (Basel). 2025;13(11):1323. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/healthcare13111323\u003c/span\u003e\u003cspan address=\"10.3390/healthcare13111323\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamkin J. Impact of airway dysfunction on dental health. Bioinformation. 2020;16(1):26\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.6026/97320630016026\u003c/span\u003e\u003cspan address=\"10.6026/97320630016026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDave RD. Sleep-disordered breathing and dental sleep medicine: implications for oral health and overall well-being. Arch Dent Res. 2023;13(1):34\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18231/j.adr.2023.007\u003c/span\u003e\u003cspan address=\"10.18231/j.adr.2023.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"obstructive sleep apnoea, breathing disorder, oral health, dental caries, snoring, daytime sleepiness, oral hygiene, malocclusion","lastPublishedDoi":"10.21203/rs.3.rs-8607189/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8607189/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Paediatric obstructive sleep apnoea (OSA) is a sleeping-disordered breathing condition widely neglected that can negatively affect the dental and systemic health of a child. The symptoms are often associated with behavioural or developmental abnormalities, and thus, it is not easy to diagnose in the early stages. OSA in untreated conditions may cause dental issues, impairment of craniofacial development, and a decrease in the overall quality of life. Dental professionals are in a distinctive position to identify warning signs early, as they may be the first to identify oral disease manifestations like malocclusion and bruxism, as well as oral hygiene issues. Therefore, the Dental practitioners have a very critical role in early screening and referral, as they are in a unique position to screen the oral symptoms of OSA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurpose and the setting:\u003c/strong\u003e This paper employed a validated questionnaire and clinical assessment to determine the connection between paediatric OSA and dental issues in children. Paediatric obstructive sleep apnoea (OSA) is an undiagnosed but common sleep disorder that can have a significant negative effect on systemic and oral health. Early detection of OSA and the associated dental symptoms is necessary to prevent the impact on behaviour, functional, and developmental problems in the long-term.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and Methods:\u003c/strong\u003e Wardha Sharad Pawar Dental College, 60 children aged 6-12 years were subject to a cross-sectional study (30 males and 30 females). Parents were provided with a questionnaire containing a few questions in order to determine the symptoms related to sleep using a validated questionnaire. The questionnaire to be used in the given study was based on the Paediatric Sleep Questionnaire (PSQ). The questionnaire was modified to simplify it so that the parents could easily understand it and fill it in accordingly. Clinical examination tests that were performed include Mallampati classification, bruxism, temporomandibular disorders, facial profile, tonsillar hypertrophy (Brodsky-score), malocclusion (Angle classification), dental caries (G.V. Black classification), and oral hygiene status. The data has been assembled using descriptive statistical analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eSnoring (63.3), daytime sleepiness (75%), and behaviour change were the most frequent OSA-related symptoms (71.6%). The prevalence of dental caries (76.6%), poor oral health (88.3%), and halitosis (61.6%) was observed among affected children, and malocclusion was observed in 30% (Class I), 41.6% (Class II), and 28.4% (Class III) of the participants. According to the Mallampati classification, 71.7 percent of children had a Class III-IV, and 53.3 percent of children had Grade 3-4 tonsillar hypertrophy. The other symptoms were bruxism (21.6), temporomandibular disorders (16.6), and a changed facial profile (18.3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The study demonstrated the reciprocal impact of airway obstruction on oral health, as it demonstrated that there was a significant correlation between paediatric OSA and dental- related issues. Early detection of the symptoms of OSA in dental practice can assist dental practitioners in referring and multidisciplinary care. The practice of screening children for sleep-disordered breathing by dentists can significantly enhance both oral and systemic health of children.\u003c/p\u003e","manuscriptTitle":"Prevalence of Sleep-Related Breathing Disorders in Children: Exploring Links Between Obstructive Sleep Apnea and Dental Disorders – A Questionnaire-Based Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 09:32:12","doi":"10.21203/rs.3.rs-8607189/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-11T05:52:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-10T06:31:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-20T09:12:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-19T19:26:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-01-19T19:19:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8fb90be6-6ff9-4179-9a65-374b5ee4dee7","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T09:32:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 09:32:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8607189","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8607189","identity":"rs-8607189","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}