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Lingual frenulum evaluation in school age children with and without sleep disordered breathing

Background: A recent study suggested that the presence of short lingual frenulum could be a “new phenotype” for paediatric sleep apnoea. Aims: In an epidemiological study we analyzed the presence of short lingual frenulum related to sleep disordered breathing (SDB) in school age children. Methods: We studied 504 school age children. Sleep clinical record (SCR) was obtained for all children. Moreover every child received orthodontic and lingual frenulum evaluation. Tongue strength, tongue peak pressure and endurance, using the Iowa Oral Performance Instrument (IOPI), were obtained in all patients. Results: We evaluated 504 children, mean age 9.6 ± 2.3 years, 277 were male. Forty-two children (8.3 %) obtained a positive SCR. Short lingual frenulum was found in 114 (22.6%) children. Children with short lingual frenulum, when compared to children with normal lingual frenulum, had a higher prevalence of male gender (54.4 vs 41%, p= 0.01), SDB (15.4 vs 6.1 %, p=0.003) and dento-skeletal malocclusions (67.5 vs 42.8%, p=0.0001). Moreover children with SDB and short lingual frenulum showed lower tongue strength measured by IOPI when compared to children without SDB (42.6±9.6 vs 47.2±10.4, p=0.04). Children with malocclusion and short lingual frenulum showed an higher odds ratio for the presence of obstructive sleep apnea (OSA) related symptoms [p Conclusion: A short lingual frenulum, associated with dento-skeletal malocclusion, is a major risk factor for SDB in school age children. An early multidisciplinary approach, including lingual frenulum evaluation, should be conducted for screening SDB.