Sleep-Disordered Breathing Across the Lifespan: An Integrated Review of Definitions, Craniofacial and Airway Anatomy, Orofacial Myofunction, Pathophysiology, Diagnosis, and Management
Keywords:
Craniofacial Abnormalities, Orofacial Myofunctional Therapy, Polysomnography, Sleep Apnea Syndromes, Sleep-Disordered Breathing.
Abstract
Sleep-disordered breathing (SDB) comprises a spectrum of conditions characterized by abnormal respiration during sleep, ranging from primary snoring to obstructive and central sleep apnea. Affecting individuals across all age groups, SDB is associated with adverse cardiovascular, metabolic, neurocognitive, and craniofacial outcomes. Contemporary understanding recognizes SDB as a heterogeneous disorder arising from the interaction of upper airway anatomy, craniofacial morphology, neuromuscular control, and ventilatory regulation. Increasing evidence highlights the contributory role of orofacial myofunctional patterns and altered craniofacial growth in both the development and persistence of disease. This review provides a comprehensive, age-independent synthesis of sleep-disordered breathing, integrating validated definitions and classifications from standard sleep medicine texts with contemporary endotype-based pathophysiological models. Upper airway anatomy, craniofacial growth, and orofacial myofunction are discussed as interrelated determinants of airway stability. Diagnostic approaches, including clinical screening, dental evaluation, and polysomnography, are reviewed. Management strategies are presented in a stratified manner, emphasizing phenotype- and endotype-specific interventions across pediatric and adult populations. A multidisciplinary, airway-centered framework involving dentistry, sleep medicine, and allied specialties is essential for effective lifelong management of sleep-disordered breathing.
References
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49. Sutherland K, Vanderveken OM, Tsuda H, et al. Oral appliance therapy update. J Clin Sleep Med. 2014;10:215-27.
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51. Caples SM, et al. Surgical modifications of upper airway. Sleep. 2010;33:1396-407.
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2. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006-14.
3. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:e714-55.
4. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien (IL): American Academy of Sleep Medicine; 2014.
5. Hoffstein V. Snoring and obstructive sleep apnea. Chest. 1996;109:201-9.
6. Guilleminault C, Li K, Khramtsov A, Pelayo R, Martinez S. Sleep-disordered breathing in children. Chest. 2003;123:12-19.
7. O’Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, et al. Neurobehavioral implications of habitual snoring in children. Pediatrics. 2004;114:44-9.
8. Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness: the upper airway resistance syndrome. Sleep. 1993;16:S94-8.
9. Bao G, Guilleminault C. Upper airway resistance syndrome—one decade later. Sleep Med Rev. 2016;28:25-34.
10. Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnea. Lancet. 2005;365:1046-53.
11. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034-41.
12. Halbower AC, Degaonkar M, Barker PB, Earley CJ, Marcus CL, Smith PL, et al. Childhood obstructive sleep apnea and neurocognitive function. Am J Respir Crit Care Med. 2006;173:1143-50.
13. Javaheri S. Central sleep apnea syndromes. Chest. 2010;137:1149-60.
14. Naughton MT. Pathophysiology and treatment of central sleep apnea. Sleep Med Rev. 2012;16:195-203.
15. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136-43.
16. Eckert DJ, Malhotra A, Jordan AS. Mechanisms of apnea. Lancet Respir Med. 2018;6:963-75.
17. Enlow DH. Facial growth. Philadelphia: Saunders; 1990.
18. Harvold EP, Tomer BS, Vargervik K, Chierici G. Primate experiments on oral respiration. Am J Orthod. 1981;79:359-72.
19. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. 6th ed. St Louis: Elsevier; 2018.
20. Schwab RJ. Upper airway imaging in obstructive sleep apnea. Am J Respir Crit Care Med. 2003;168:522-30.
21. Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and upper airway morphology in pediatric obstructive sleep apnea. Sleep Med Rev. 2013;17:347-58.
22. Pirilä-Parkkinen K, Löppönen H, Nieminen P, Tolonen U, Pääkkö E. Craniofacial morphology in children with obstructive sleep apnea. Eur J Orthod. 2010;32:488-94.
23. Sutherland K, Cistulli PA. Oral appliance therapy for obstructive sleep apnea. Sleep Med Rev. 2014;18:9-21.
24. American Speech-Language-Hearing Association. Orofacial myofunctional disorders. Rockville (MD): ASHA; 2020.
25. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea. J Clin Sleep Med. 2017;13:479-504.
26. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383:736-47.
27. Eckert DJ. Phenotypic approaches to obstructive sleep apnoea. Sleep Med Rev. 2018;37:45-59.
28. Lobbezoo F, Ahlberg J, Raphael KG, Wetselaar P, Glaros AG, Kato T, et al. Dental sleep medicine overview. J Oral Rehabil. 2016;43:457-67.
29. Huynh NT, Desplats E, Almeida FR. Craniofacial phenotypes in obstructive sleep apnea. Sleep Med Rev. 2014;18:167-78.
30. Sanders AE, Essick GK, Fillingim R, Knott C, Ohrbach R, Greenspan JD. Sleep apnea symptoms and temporomandibular disorder pain. J Dent Res. 2013;92:1133-9.
31. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165:1217-39.
32. Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, et al. Sleep disorders and orofacial pain. Sleep Med Rev. 2009;13:201-10.
33. Dubrovsky B, et al. Sleep disruption and chronic pain interactions. Sleep Med Rev. 2014;18:7-15.
34. Beebe DW. Neurobehavioral morbidity associated with pediatric obstructive sleep apnea. Sleep. 2006;29:1115-34.
35. Manfredini D, Lobbezoo F. Relationship between bruxism and sleep disorders. J Oral Rehabil. 2009;36:549-59.
36. Chung F, Yegneswaran B, Liao P, et al. STOP-Bang questionnaire validation. Anesthesiology. 2008;108:812-21.
37. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14:540-5.
38. Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire validation. Sleep Med. 2000;1:21-32.
39. Schwab RJ. Upper airway imaging. Proc Am Thorac Soc. 2008;5:185-92.
40. Saito H, et al. Craniofacial morphology in OSA and TMD patients. Angle Orthod. 2018;88:193-200.
41. Zonato AI, et al. Craniofacial risk factors for OSA. Arch Otolaryngol Head Neck Surg. 2003;129:1099-105.
42. Ono T, et al. Mandibular position and upper airway patency. J Oral Rehabil. 2000;27:119-25.
43. Villa MP, et al. Rapid maxillary expansion in pediatric OSA. Sleep Med Rev. 2011;15:65-73.
44. Friedman M, et al. Mallampati score and OSA prediction. Otolaryngol Head Neck Surg. 1999;120:540-7.
45. Guijarro-Martínez R, Swennen GR. CBCT airway analysis. Int J Oral Maxillofac Surg. 2011;40:687-95.
46. Lowe AA, et al. Cephalometric analysis in OSA. Am J Orthod Dentofacial Orthop. 1996;109:163-72.
47. Collop NA, et al. Home sleep testing guidelines. J Clin Sleep Med. 2017;13:1205-7.
48. Kezirian EJ, et al. Drug-induced sleep endoscopy. Laryngoscope. 2011;121:1320-8.
49. Sutherland K, Vanderveken OM, Tsuda H, et al. Oral appliance therapy update. J Clin Sleep Med. 2014;10:215-27.
50. Doff MHJ, et al. Long-term oral appliance therapy effects on TMJ. J Dent Res. 2013;92:382-7.
51. Caples SM, et al. Surgical modifications of upper airway. Sleep. 2010;33:1396-407.
52. Edwards BA, et al. Loop gain and OSA pathogenesis. Am J Respir Crit Care Med. 2014;190:1293-302.
53. Eckert DJ, et al. Arousal threshold in OSA. Sleep. 2011;34:149-55.
Published
2026-07-23
How to Cite
Jain Choudhary, P., & Ganiga Channaiah Shivkumar. (2026). Sleep-Disordered Breathing Across the Lifespan: An Integrated Review of Definitions, Craniofacial and Airway Anatomy, Orofacial Myofunction, Pathophysiology, Diagnosis, and Management. UNIVERSITY JOURNAL OF DENTAL SCIENCES, 12(2). https://doi.org/10.21276/ujds.2026.12.2.31
Section
Review Article
