A longitudinal cohort study of sleep-disordered breathing in children: interrelationships with craniofacial morphology, malocclusion, and intervention outcomes

This prospective longitudinal cohort study aimed to investigate the prevalence, risk factors, and craniofacial correlates of sleep-disordered breathing (SDB) in children, and to evaluate the efficacy of targeted interventions in a nested sub-study. A total of 1,589 children (aged 6–9 years) were enrolled and followed for 36 months. Assessments included Portable polysomnography, cone-beam computed tomography, 3D facial imaging, and standardized clinical examinations. A sub-study of 275 children with moderate-to-severe SDB (obstructive apnea–hypopnea index, OAHI ≥ 5) were allocated to ENT intervention (adenotonsillectomy), orthodontic intervention (rapid maxillary expansion), or control groups. The baseline prevalence of SDB was 28.9%, with a significant male predominance. Multivariate analysis identified adenotonsillar hypertrophy (aOR = 3.42), paternal snoring (aOR = 2.38), obesity (aOR = 2.15), and allergic rhinitis (aOR = 1.86) as key independent risk factors. Children with SDB exhibited distinct craniofacial features, including reduced airway volume, mandibular retrusion, and a 38.2% smaller minimum cross-sectional area. Strong associations were found between SDB and specific malocclusions, including Class II malocclusion (48.6% vs. 27.3%), increased overjet, and posterior crossbite. A bidirectional relationship was observed, where SDB persistence worsened occlusal traits, while SDB remission facilitated spontaneous improvement. In the intervention sub-study, both ENT (68.4% resolution) and orthodontic (52.1% resolution) groups showed significant improvement in OAHI and quality of life scores compared to controls (15.7%). Cost-effectiveness analysis favored the ENT intervention while acknowledging the additional occlusal benefits of orthodontic treatment. SDB is highly prevalent and dynamically interacts with craniofacial growth and occlusal development in children. An interdisciplinary approach, incorporating both ENT and orthodontic perspectives, is supported for effective management, leading to improved respiratory, dentofacial, and quality-of-life outcomes.