Risk of pediatric obstructive sleep apnea in preadolescent children with orthodontic anomalies: A diagnostic study

Background This study aimed to investigate the relationships among the risk of pediatric obstructive sleep apnea (POSA), the presence of orthodontic malocclusions, and oral breathing. Methods Children aged 6 to 12 years, of (nationality) or (nationality) nationality, who were referred for orthodontic examination were included in the study. Evaluated cranio-maxillofacial features included maxillary arch constriction, anomalies in the number and position of teeth, dental arch relationship, skeletal class, mandibular growth pattern, and tongue range of motion ratio. POSA risk was assessed using overnight home sleep polygraphy. A stepwise linear regression model was developed to evaluate the relationship between clinically significant variables and apnea-hypopnea index (AHI). Results A total of 100 children participated in the study, with 61% showing increased risk for mild POSA and 7% for moderate POSA, respectively. AHI (treated as a continuous variable) positively correlated with maxillary arch constriction, overjet, increased ANB angle, mandibular crowding, and oral breathing preference, and negatively with the tongue range of motion ratio (correlation coefficients 0.2–0.47). The final linear regression model containing four parameters (maxillary arch constriction, mandibular crowding, increased ANB angle, and oral breathing preference) explained 77.8% of AHI variance, with a mean error in AHI prediction of 0.91. Conclusions Our study confirmed the multifactorial nature of POSA and the elevated risk of POSA in the orthodontic population. Including craniofacial features with small effect sizes in the model improved its performance, highlighting the importance of considering multiple contributing factors rather than isolated predictors when assessing POSA risk.