title: Polysomnographic findings are associated with cephalometric measurements in mouth-breathing children.
abstract: OBJECTIVE
  Children with adenotonsillar hypertrophy and those with an abnormal craniofacial morphology are predisposed to having sleep disordered breathing; many of these children are mouth breathers. The aim of this study was to determine whether an association exists between polysomnographic findings and cephalometric measures in mouth-breathing children.
  
  
  METHODS
  Twenty-seven children (15 mouth-breathing children and 12 nose-breathing children [control subjects]), aged 7 to 14 years, took part in the study. Polysomnographic variables included sleep efficiency, sleep latency, apnea-hypopnea index, oxygen saturation, arousal index, number of periodic limb movements in sleep, and snoring. Cephalometric measures included maxilla and mandible position, occlusal and mandibular plane inclination, incisor position, pharyngeal airway space width, and hyoid bone position.
  
  
  RESULTS
  As compared with nose-breathing children, mouth breathers were more likely to snore (p < 0.001) and to have an apnea-hypopnea index greater than 1 (p = 0.02). Mouth-breathing children were also more likely to have a retruded mandible, more inclined occlusal and mandibular planes, a smaller airway space, and a smaller superior pharyngeal airway space (p < 0.01). The apnea-hypopnea index increased as the posterior airway space decreased (p = 0.05).
  
  
  CONCLUSIONS
  Our study showed an association between polysomnographic data and cephalometric measures in mouth-breathing children. Snoring was the most important variable associated with abnormal craniofacial morphology. Orthodontists should send any mouth-breathing child for an evaluation of sleep if they find that the child has a small superior pharyngeal airway space or an increased ANB (the relationship between the maxilla and mandible), NS.PIO (occlusal plane inclination in relationship to the skull base), or NS.GoGn (the mandibular plane inclination in relation to the skull base), indicating that the child has a steeper mandibular plane.
authors.affiliation: Neuro-Sono Section, Department of Neurology, Universidade ederal de São Paulo, Brazil. lijuliano@ig.com.br
authors.forename: Maria Ligia
authors.initials: ML
authors.lastname: Juliano
authors.forename: Marco Antonio Cardoso
authors.initials: MA
authors.lastname: Machado
authors.forename: Luciane Bizari Coin
authors.initials: LB
authors.lastname: de Carvalho
authors.forename: Edilson
authors.initials: E
authors.lastname: Zancanella
authors.forename: Gianni Mara Silva
authors.initials: GM
authors.lastname: Santos
authors.forename: Lucila Bizari Fernandes
authors.initials: LB
authors.lastname: do Prado
authors.forename: Gilmar Fernandes
authors.initials: GF
authors.lastname: do Prado
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002508:Cephalometry / Q000379:methods* / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009058:Mouth Breathing / Q000453:epidemiology*; D015588:Observer Variation; D017286:Polysomnography / Q000379:methods* / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012913:Snoring / Q000453:epidemiology
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