Student Theses, Dissertations and Capstones

Document Type


Degree Name

Master of Science (M.S.) in Dentistry

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.


College of Dental Medicine

First Advisor

Jorge C Coro

Second Advisor

Patrick Hardigan

Third Advisor

Nydia Cummings

Publication Date / Copyright Date



Nova Southeastern University


Introduction: Sleep-disordered breathing (SDB) is a term for breathing difficulties occurring during sleep and encompasses frequent loud snoring to Obstructive Sleep Apnea (OSA). SDB in children has been linked to daytime sleepiness, poor school performance, hyperactivity, cardiovascular complications, impaired overall growth, development of malocclusion, and craniofacial disharmony. The American Academy of Pediatrics and the American Association of Orthodontists (AAO) urge more studies to educate about etiology, symptoms, and sequelae of SDB. Therefore, this study proposed to investigate the association between symptoms of SDB and malocclusion and craniofacial disharmony in children. Methods: The Pediatric Sleep Questionnaire (PSQ) was used to obtain cross-sectional data from a sample of parents attending their child’s appointment at Nova Southeastern University’s Orthodontic Clinic. Additional questionnaire items included literature-supported SDB-related sociodemographic and clinical history information. Specific variables of malocclusion and craniofacial disharmony were analyzed using the child’s photos and casts. Univariate, bivariate, and multivariable logistic regression analyses were used to assess the specific aims. Results: Of 147 participants, sixteen children (10.9%) were at risk for SDB. Significant bivariate associations were found between risk for SDB and tonsilloadenoidectomy (p = 0.015) and allergies (p = 0.041). The final model indicated children with a tonsilloadenoidectomy were 83.6% less likely to be at risk for SDB (adjusted odds ratio [AOR] = 0.164, 95% confidence interval [CI] 0.034, 0.795). Ten children (6.8%) were at risk for snoring. The final model for snoring risk indicated that children who qualified for free/reduced lunch were 4.5 times more likely to be at risk for snoring (AOR=4.533, 95% CI 1.037-19.806) while children with a deep/narrow palate were 84.8% less likely to be at risk for snoring (AOR=0.152, 95% CI 0.033, 0.693). Conclusions: Though no significant associations were found between the children’s dentofacial measurements and the parent responses on the PSQ, a history of tonsilloadenoidectomy produced a significant association with risk of SDB. Additionally, significant associations with snoring risk were found with qualification for free/reduced lunch and palatal measurements. Our findings suggest that orthodontists are at unique position to screen for SDB and snoring. Our study proposes the PSQ, with additional SDB-related medical history questions and dentofacial measurements, for orthodontists to use as a screening tool.




Craniofacial, Disharmony, Malocclusion, Orthodontics, Sleep-disordered breathing, Pediatric orthodontic patients, Patient-reported symptoms, Sleep Apnea, Daytime sleepiness, Poor school performance, Hyperactivity, Cardiovascular complications, Medical history questions



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