# Sleep Breathing Disorders' Screening Among Children
## 4 Discussion  
The study data on the suspicion of sleep-disordered breathing (SDB) in children attending the orthodontic department for interceptive therapy were collected to identify patients at risk of suffering from SDB. The gold standard for diagnosing SDB is overnight polysomnography. However, due to its time-consuming and expensive nature, several alternative screening tools, such as questionnaires, have been proposed as more cost-effective and efficient options [19]. The Pediatric Sleep Questionnaire (PSQ), developed by [PERSON] et al. in 2000 [30], is the most widely used, with a sensitivity of 0.85 and specificity of 0.87 (cutoff 0.33) for identifying SDB in otherwise healthy children aged 2-18 years, as confirmed by polysomnography. The STOP-Bang questionnaire is commonly used in adults to predict obstructive sleep apnea syndrome (OSAS) risk and the need for polysomnography (PSG), with a modified version for adolescents (teen STOP-Bang) [31]. In our study, we used the more recent Sleep Clinical Record (SCR) developed by [PERSON] et al. in 2013 [25], which has a sensitivity of 96.05% and specificity of 67%. The SCR takes 30-60 min to complete and, unlike other questionnaires, combines clinical history with physical examination findings. The prevalence of sleep disorders in children aged 0-17 years is 2.36%, with OSA being the most common SDB in 1.17% of cases [32]. This prevalence is higher in studies from the past decade, where it ranges from 12.8% to 20.4% [14]. OSA primarily affects children aged 2 to 8 years, with a prevalence ranging from 1% to 6% [12]. However, diagnosing SDB in children remains challenging, similar to pediatric bruxism, with which there is a strong association [33]. Several risk factors are recognized as predisposing children to SDB [34], with specific anatomical conditions, such as reduced posterior airway space, playing a role in the development of OSA. It has recently been demonstrated that promoting healthier upper airway growth from birth, such as through breastfeeding, reduces the risk of developing SDB [35]. Other studies have shown significant reductions in mandibular body length, skull base, and oropharyngeal width in children with OSAS, along with changes in facial morphology, such as increased anterior facial height and reduced posterior facial height [33]. A convex facial profile due to retrognathism of the maxilla and mandible also predisposes children to SDB, a trait that can persist into adulthood in individuals with OSAS [35]. In our study, we analyzed a sample of 48 patients (17 males, 31 females) with an average age of 8 years. The main finding of our study is that nearly 70% of children undergoing orthodontic evaluations are at risk for SDB. We found a much higher prevalence of SDB in our selective sample compared to the general pediatric population, where the prevalence is about 10% [36]. Our results are notably higher than those reported by other authors, who found that approximately 7% of children seeking orthodontic evaluation were at risk for SDB [15]. However, their study enrolled older patients, predominantly \begin{table}
\begin{tabular}{c c} \hline
**SCR, Over** & \(p\)**-Value** \\ \hline Oral breathing & \(p=0.0226\) * \\ Habitual nasal obstruction & \(p=0.0336\) * \\ Tonsillar hypertrophy & \(p=0.0004\) * \\ Malocclusions & \(p=0.0126\) * \\ Narrow palate & \(p=0.0130\) * \\ Friedman score & \(p=0.0167\) * \\ Facial phenotype & \(p=0.0023\) * \\ Brouillette score & \(p=0.0147\) * \\ \hline \end{tabular} The \(p\)-value (\(p\)) of each SCR over the parameters calculated using the Kruskal–Wallis equality-of-populations rank test. The \(p\)-value (\(p\)) lower than 0.05 is marked by ***.  
\end{table} 
Table 6: The results of the Kruskal–Wallis equality-of-populations rank test. adolescents, which makes direct comparison challenging. In a study of 668 pediatric patients, the PSQ was administered to assess the prevalence of SDB during the first dental visit, with 10% of children identified as at risk for SDB [37].