Alterações craniofaciais, distúrbios respiratórios do sono e desempenho escolar em crianças e adolescentes de Santa Maria, RS

Abstract

This thesis consists of two articles. The objective of article I is to evaluate the association between malocclusions, sleep-disordered breathing and poor school performance in children. Article II is to identify which malocclusions and alterations in the size of the palate are associated with snoring in children. This work is a cross-sectional study with a sample of 547 children in the mixed dentition phase, between 07 and 13 years old, from the city of Santa Maria -RS. A two-stage cluster random sampling procedure was adopted. The sample was evaluated and the data were obtained through questionnaires, dental and speech examinations. In Article I, Structural Equation Modeling (SEM) was performed to test the pathways between demographic, socioeconomic, and oral health measures in school performance. Academic performance was measured by parents' perception of the students' academic performance, learning problems and school failure. Subsequently, the structural model analyzed the magnitude and direction of the paths between the observed and latent variables. The model's goodness of fit was evaluated using different parameters: Root Mean Square Error of Approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); and the Coefficient of Determination (CD). In article II, a descriptive analysis was performed to assess the characteristics of the sample in general and according to the prevalence of snoring. Unadjusted and adjusted Poisson regression analysis with robust variance was performed to assess the association between predictor variables and the occurrence of snoring. A secondary analysis was performed considering the interaction between palate measurements (depth and width) with the presence of different malocclusions (anterior open bite, accentuated overjet, and posterior crossbite) to assess their combined impact on the occurrence of snoring. The results of article I were: male gender, older age, lower level of maternal education, sleepdisordered breathing, oral or oronasal breathing mode were directly associated with poor school performance. Children who did not receive exclusive breastfeeding in the first 6 months of life showed a direct association with worse performance, in addition, non-exclusive breastfeeding indirectly impacted sleep disorder via oral or oronasal breathing mode. In the second, the prevalence of snoring was 25.1%. Children who did not have an anterior open bite, but had a narrow hard palate, were more likely to snore. Regardless of hard palate width, individuals with severe overjet had a higher prevalence of snoring. Children with a deep and narrow hard palate associated with the presence of posterior crossbite also had a higher prevalence of snoring. We highlight the importance of exclusive breastfeeding in the first 6 months of life as an important factor in the prevention of sleep-disordered breathing and problems related to school performance, in addition to assessing the size of the palate in children and not just the presence of malocclusions, since an altered dimension can already predispose to the presence of childhood snoring