European Journal of Pediatrics

, Volume 171, Issue 12, pp 1747–1752 | Cite as

Craniofacial morphology but not excess body fat is associated with risk of having sleep-disordered breathing—The PANIC Study (a questionnaire-based inquiry in 6–8-year-olds)

  • Tiina IkävalkoEmail author
  • Henri Tuomilehto
  • Riitta Pahkala
  • Tuomo Tompuri
  • Tomi Laitinen
  • Riitta Myllykangas
  • Anu Vierola
  • Virpi Lindi
  • Matti Närhi
  • Timo A. Lakka
Leading Article


We investigated the associations of dental occlusion, other craniofacial features and body fat with paediatric sleep-disordered breathing (SDB) in a representative population sample of 491 Finnish children 6–8 years of age. Overweight and obesity were defined using age- and sex-specific body mass index cutoffs by International Obesity Task Force (IOTF) criteria. Body fat percentage was assessed by dual-energy X-ray absorptiometry. Facial proportions, dental occlusion and soft tissue structures were evaluated by an orthodontist. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The prevalence of SDB was 9.9 % with no difference between boys and girls. The median (interquartile range) of body fat percentage was 20.6 (17.4–27.1) in girls and 15.0 (11.4–21.6) in boys. Altogether 11.4 % of boys and 15.6 % of girls were classified as having overweight or obesity according to the IOTF criteria. There was no difference in the prevalence of overweight, obesity or body fat percentage between children with SDB and those without it. Children with tonsillar hypertrophy had a 3.7 times higher risk of suffering SDB than those with normal size tonsils after adjustment for age, sex and body fat percentage. Furthermore, children with cross bite had a 3.3 times higher risk of having SDB than those without cross bite, and children with a convex facial profile had a 2.6 times higher risk of having SDB than those with a normal facial profile. Conclusion: Abnormal craniofacial morphology, but not excess body fat, is associated with an increased risk of having SDB in 6–8-year-old children. A simple model of necessary clinical examinations (i.e. facial profile, dental occlusion and tonsils) is recommended to recognize children with an increased risk of SDB.


Sleep-disordered breathing Craniofacial abnormalities Dental occlusion Tonsillar hypertrophy Overweight Obesity Childhood 



We thank the voluntary children and their parents who participated in the present study. We are also most indebted to the PANIC Study researchers for their skillful contribution in performing the study. This work has been financially supported by grants from the Ministry of Social Affairs and Health of Finland, the Ministry of Education and Culture of Finland the Finnish Innovation Fund Sitra, the Social Insurance Institution of Finland, the Finnish Cultural Foundation, the Juho Vainio Foundation, the Foundation for Paediatric Research, the Paavo Nurmi Foundation and the Kuopio University Hospital (EVO-funding number 5031343).

Conflict of interest

The authors declare that there is no conflict of interests.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Tiina Ikävalko
    • 1
    • 2
    Email author
  • Henri Tuomilehto
    • 3
  • Riitta Pahkala
    • 1
    • 2
  • Tuomo Tompuri
    • 4
    • 5
  • Tomi Laitinen
    • 5
  • Riitta Myllykangas
    • 1
  • Anu Vierola
    • 4
  • Virpi Lindi
    • 4
  • Matti Närhi
    • 2
    • 4
  • Timo A. Lakka
    • 4
    • 6
  1. 1.Oral and Maxillofacial DepartmentKuopio University HospitalKuopioFinland
  2. 2.Institute of DentistryUniversity of Eastern FinlandKuopioFinland
  3. 3.Department of OtorhinolaryngologyKuopio University HospitalKuopioFinland
  4. 4.Department of Physiology, Institute of BiomedicineUniversity of Eastern FinlandKuopioFinland
  5. 5.Department of Clinical Physiology and Nuclear MedicineKuopio University Hospital and University of Eastern FinlandKuopioFinland
  6. 6.Kuopio Research Institute of Exercise MedicineKuopioFinland

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