# Sleep Breathing Disorders' Screening Among Children
## 1 Introduction  
Sleep-disordered breathing (SDB) encompasses a spectrum of conditions characterized by abnormal breathing during sleep, with simple snoring and obstructive sleep apnea (OSA) being the most frequently identified disorders [1]. Obesity is a significant risk factor, as the prevalence of OSA among obese children ranges from 19% to 61% [2, 3, 4, 5]. Specifically, for each increase in body mass index (BMI) above the 50 th percentile, the risk of OSA rises by 10-12% [6, 7]. Adenoid and tonsillar hypertrophy are also recognized risk factors due to the volumetric reduction they cause in the upper airways; accordingly, adenotonsillectomy is the recommended treatment for pediatric OSA [8]. Allergic rhinitis, by inducing nasal mucosal inflammation and congestion, increases airway resistance and contributes to SDB [9]. The most commonly encountered symptoms in children refer to frequent snoring (>3 nights/week), shortness of breath during sleep, snorting, enuresis, sleeping in a sittingposition, headache upon awakening, daytime drowsiness, attention-deficit/hyperactivity disorder (ADHD), and learning problems [10]. Additionally, malocclusion and maxillofacial anomalies are associated with pediatric OSA. Transverse maxillary constriction with a high, narrow palatal vault is a significant risk factor, as are changes in jaw or tongue size, position, or geometry, which can further narrow the upper airway and increase obstruction risk [11,12].  
Pediatric OSA primarily affects children aged 2 to 8 years, with recent studies reporting a prevalence of 12.8% [13,14]. SDB and OSA are even more prevalent in orthodontic populations, with reported risks ranging from 7% to 47.7% [15, 16, 17].  
Although overnight polysomnography is the gold standard for diagnosing SDB [18], its cost and time requirements have led to the development of alternative screening tools, such as questionnaires [19]. Dentists, especially orthodontists, play a crucial role in the early detection of OSA by identifying high-risk patients and correcting malocclusions linked to the condition, such as narrow palates or mandibular retrusion [20]. Promoting pediatric OSA screening in dental practice, akin to general oral prophylaxis and education, is a valuable initiative [21, 22, 23].  
This study hypothesizes that orthodontic evaluation, paired with a validated screening questionnaire, can effectively identify pediatric patients at risk for SDB. By employing the Sleep Clinical Record (SCR) as a rapid and cost-effective tool, this study seeks to establish a link between orthodontic factors and SDB risk, providing insights into the role of orthodontics in early detection and management.  
The multifactorial nature of SDB suggests that a multidisciplinary approach is essential for effective diagnosis and intervention. This study aims to bridge the gap between dentistry and sleep medicine by exploring the association between orthodontic variables--such as malocclusion, oral breathing, and tonsillar hypertrophy--and SDB indicators. This preliminary research lays the groundwork for future studies to refine screening tools and interventions, ultimately enhancing pediatric health outcomes.