Citation Information :
Kalaskar R, Bhaje P, Kalaskar A, Faye A. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing. Int J Clin Pediatr Dent 2021; 14 (5):604-609.
Aims and objectives: Persistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing.
Materials and methods: A cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children\'s sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson\'s correlation coefficient test were utilized during the analysis. p value of <0.05 was considered significant.
Results: Out of 100 children, 70 were males and 30 were females. On the CSHQ scale, the highest score was found on sleep-disordered breathing followed by sleep onset delay and daytime sleepiness. The commonest symptom of inattention was “failing to give close attention in school” (73%) whereas the commonest symptom of hyperactivity was “trouble waiting for his/her turn” (66%). Seven participants satisfied complete criteria for ADHD. Sleep duration and daytime sleepiness had a significant negative correlation with hyperactivity (p < 0.05). A positive correlation was observed between daytime sleepiness and inattention (p < 0.01).
Conclusion: Children with sleep disturbances or ADHD should be assessed for the presence of mouth breathing, as early identification and correction of mouth breathing may help to prevent unnecessary exposure to the medication.
Clinical significance: Children with ADHD or sleep disturbances should always be assessed for the presence of mouth breathing. Early identification and correction of mouth breathing may help in preventing unnecessary exposure to medication for treating ADHD.
Abreu RR, Rocha RL, Lamounier JA, et al. Etiology, clinical manifestations and concurrent findings in mouth-breathing children. J Pediatr (Rio J) 2008;84(6):529–535. DOI: 10.2223/JPED.1844.
Costa EC, Sabino HAC, Miura CS, et al. Atopia e hipertrofia adenoamigdaliana em pacientes respiradores bucais em um centro de referência. Braz J Otorhinolaryngol 2013;79(6):663–667. DOI: 10.5935/1808-8694.20130123.
Menezes VA, Tavares RLO, Granville-Garcia AF. Síndrome da respiração oral: alteraçõesclínicas e comportamentais. Arq Odontol 2009;45:160–165.
Cunha DA, Silva GAP, Motta MEFA, et al. Mouth breathing in children and its repercussions in the nutritional state. Rev CEFAC 2007;9(1):47–54. DOI: 10.1590/S1516-18462007000100007.
Cattoni DM, Fernandes FDM, Di Francesco RC, et al. Characteristics of the stomatognathic system of mouth breathing children: anthroposcopic approach. Pro Fono 2007;19(4):347–351. DOI: 10.1590/s0104-56872007000400004.
Raskin S, Limme M, Poirrier R. Could mouth breathing lead to obstructive apnea syndrome. A preliminary study [article in French]. Orthod Fr 2000;71(1):27–35.
Huang YS, Guilleminault C, Li HY, et al. Attention-deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study. Sleep Med 2007;8(1):18–30. DOI: 10.1016/j.sleep.2006.05.016.
Schredl M, Alm B, Sobanski E. Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 2007;257(3):164–168. DOI: 10.1007/s00406-006-0703-1.
Shur-Fen Gau S. Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6-15 in Taiwan. Sleep Res 2006;15(4):403–414. DOI: 10.1111/j.1365-2869.2006.00552.x.
Philipsen A, Feige B, Hesslinger B, et al. Sleep in adults with attention-deficit/hyperactivity disorder: a controlled polysomnographic study including spectral analysis of the sleep EEG. Sleep 2005;28(7):877–884. DOI: 10.1093/sleep/28.7.877.
Jefferson Y. Mouth breathing: adverse effects on facial growth, health, academics, and behavior. Gen Dent 2010;58(1):18–25.
Seifer R, Sameroff A, Dickstein S, et al. Parental psychopathology and sleep variation in children. Sleep Dis 1996;5(3):715–727. DOI: 10.1016/S1056-4993(18)30358-4.
Owens J, Maxim R, Nobile C, et al. Television viewing habits and sleep disturbances in school-aged children. Pediatrics 1999;104(3):e27. DOI: 10.1542/peds.104.3.e27.
Owens JA, Spirito A, McGuinn M. The children's sleep habits questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 2000;23(8):8. DOI: 10.1093/sleep/23.8.1d.
Kuroishi RC, Garcia RB, Valera FC, et al. Deficits in working memory, reading comprehension and arithmetic skills in children with mouth breathing syndrome: analytical cross-sectional study. Sao Paulo Med J 2015;133(2):78–83. DOI: 10.1590/1516-3180.2013.7630011.
Abreu RR, Rocha RL, Lamounier JA, et al. Prevalence of mouth breathing among children. J Pediatr (Rio J) 2008;84(5):467–470. DOI: 10.2223/JPED.1806.
Bourke R, Anderson V, Yang JS, et al. Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing. Sleep Med 2011;12(5):489–496. DOI: 10.1016/j.sleep.2010.11.010.
Won DC, Guilleminault C, Koltai PJ, et al. It is just attention-deficit hyperactivity disorder…or is it? J Dev Behav Pediatr 2017;38(2):169–172. DOI: 10.1097/DBP.0000000000000386.
Lange H, Buse J, Bender S, et al. Accident proneness in children and adolescents affected by ADHD and the impact of medication. J Atten Disord 2012;20(6):501–509.
Mehmet İZ, Çeri V. Prevalence of attention deficit hyperactivity disorder symptoms in children who were treated at emergency service due to unintentional injury. Emerg Med Int 2018;2018:7814910. DOI: 10.1155/2018/7814910.
Polanczyk GV, Salum GA, Sugaya LS, et al. Annual research review: a meta-analysis of the world wide prevalence of mental disorders in children and adolescents. J Child Psycholo Psychia Allied Discip 2015;56(3):345–365. DOI: 10.1111/jcpp.12381.
Mitchell RB, Kelly J. Long-term changes in behavior after adenotonsillectomy for obstructive sleep apnea syndrome in children. Otolaryngol Head Neck Surg 2006;134(3):374–378. DOI: 10.1016/j.otohns.2005.11.035.
Fidan T, Fidan V. The impact of adenotonsillectomy on attention-deficit hyperactivity and disruptive behavioral symptoms. Eurasian J Med 2008;40(1):14–17.
Chervin RD, Archbold KH, Dillon JE, et al. Inattention, hyperactivity and symptoms of sleep-disordered breathing. Pediatrics 2002;109(3):449–456. DOI: 10.1542/peds.109.3.449.
Chervin RD, Archbold KH, Dillon JE, et al. Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements. Sleep 2002;25(2):213–218.
O'Brien LM, Holbrook CR, Mervis CB, et al. Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 2003;111(3):554–563. DOI: 10.1542/peds.111.3.554.
Corkum P, Moldofsky H, Hogg-Johnson S, et al. Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and stimulant medication. J Am Acad Child Adolesc Psychiatry 1999;38(10):1285–1293. DOI: 10.1097/00004583-199910000-00018.
O'Brien LM, Ivanenko A, Crabtree VM, et al. The effect of stimulants on sleep characteristics in children with attention deficit/hyperactivity disorder. Sleep Med 2003;4(4):309–316. DOI: 10.1016/s1389-9457(03)00071-6.
Petry C, Pereira MU, Pitrez PMC, et al. The prevalence of symptoms of sleep-disordered breathing in Brazilian schoolchildren. J Pediatr 2008;84(2):123–129. DOI: 10.2223/JPED.1770.
Owens JA, Sangal RB, Sutton VK, et al. Subjective and objective measures of sleep in children with attention-deficit/hyperactivity disorder. Sleep Med 2009;10(4):446–456. DOI: 10.1016/j.sleep.2008.03.013.
Gottlieb DJ, Vezina RM, Chase C, et al. Symptoms of sleep-disordered breathing in 5-year-old children are associated with sleepiness and problem behaviors. Pediatrics 2003;112(4):870–877. DOI: 10.1542/peds.112.4.870.
Junqueira P, Marchesan I, Regina de Oliveira L, et al. Speech-language pathology findings in patients with mouth breathing: multidisciplinary diagnosis according to etiology. Int J Orofacial Myology 2010;36(1):27–32. DOI: 10.52010/ijom.2010.36.1.3.
Felcar JM, Bueno IR, Massan AC, et al. Prevalence of mouth breathing in children from an elementary school. Cien Saude Colet 2010;15(2):437–444. DOI: 10.1590/S1413-81232010000200020.