Overall analysis of Maxillofacial portraits in children with sleep breathing disorders: A cross-sectional study

Objective The prevalence of sleep-disordered breathing (SDB) has not been adequately studied among urban children aged 3 to 11 years. Furthermore, meaningful risk characteristics applicable to population-based screening, particularly in East Asian populations, remain limited. This study aimed to investigate the current prevalence of SDB across different pediatric age groups and to identify potential high-risk phenotypic profiles. Methods A cross-sectional study was conducted in Shanghai, China, using a randomized cluster sampling approach among children aged 3-11 years. Clinical evaluations by dental professionals included assessments of craniofacial morphology, dental occlusion, and tonsil size. Additional data were collected on sociodemographic factors, medical history, and responses to the PSQ-22 and OSA-18 sleep questionnaires. A two-step cluster analysis was performed to automatically group individuals based on shared characteristics. Results A total of 1,624 children from 31 schools were included in the analysis, with 14.78% identified as being at risk for SDB. Three distinct clusters were identified for both preschool and school-aged children, based on combinations of demographic variables, craniofacial features, dental occlusion, and tonsil size. Significant differences in questionnaire scores and positivity rates were observed across clusters. Key risk profiles included preschool-aged children with convex facial profiles, distal occlusion, and deep overbite/overjet, as well as school-aged children with relevant medical histories (adenotonsillar hypertrophy, chronic rhinitis), pronounced dental crowding, straight or convex profiles, Class I/II molar tendencies, and deep overbite/overjet. Conclusions Through cluster analysis incorporating craniofacial characteristics, this study proposed age-specific phenotypic screening profiles for pediatric SDB. The findings provide useful insights for future epidemiological research and the early identification of high-risk children.