Sleep-related breathing disorders (SRBD) and attention-deficit/hyperactivity disorder (ADHD) in children attending an orthodontic clinic: a pilot case-control study

• A highly significant difference was observed between ADHD cases and controls for the global PSQ-SRBD severity score. It should be noted that the restricted PSQ-SRBD severity scores without the behavior-related questions were also different. • A mean mandibular deviation to the left was observed in ADHD patients compared to controls. • There was therefore a potential association between SRBD, ADHD symptoms and malocclusions, but no causal link. : Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children. Sleep-related breathing disorders (SRBD), often caused by craniofacial abnormalities narrowing the airway, may be associated with ADHD. Therefore, orthodontists involved in the diagnosis and the treatment of sleep disorders should also be concerned by ADHD. The primary objective of this study was to explore the association between SRBD and ADHD in children referred to an orthodontic clinic. The study also investigated cephalometric characteristics in these children. : This pilot case-control study included 22 children attending an orthodontic clinic: 11 ADHD children diagnosed by a neuropsychologist and 11 control children matched for age, gender, BMI, and ethnicity. Control subjects were free of ADHD according to DSM-V classification. Type 3 ventilator polygraphy and cephalometric radiographs were performed. Parents answered the pediatric sleep questionnaire regarding SRBD symptoms of their child (PSQ-SRBD). A severity score and a restricted version of it removing 6 questions on behaviour were calculated. Both scores range from 0 to 1 with high values indicative of SRBD. : ADHD children evidenced a higher PSQ-SRBD severity score than controls (0.50 ± 0.14 vs. 0.11 ± 0.11, mean difference 0.39 ± 0.16, p<0.0001) and similarly for the restricted score (0.33 ± 0.17 vs. 0.058 ± 0.056, mean difference 0.37 ± 0.17, p=0.0003). Ventilator polygraphy parameters although not significantly different between groups were always higher in ADHD children (e.g. ventilatory effort 17.3 ± 7.0 vs 14.5 ± 12.3%; sleep fragmentation 14.5 ± 4.8 vs 13.5 ± 7.3 micro-arousals/h). Cephalometric features were comparable but ADHD subjects showed more mandibular deviation to the left (p=0.032). : Children with ADHD were more likely to suffer from sleep-related breathing disorders according to the PSQ-SRBD severity score, although the polygraph results did not confirm this finding. As for craniofacial anomalies, they only showed more mandibular deviation to the left. ADHD is important in pediatric, ENT and orthodontic practice to manage treatment of children optimally.