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The influence of snoring, mouth breathing and apnoea on facial morphology in late childhood: a three-dimensional study
  1. Ala Al Ali1,
  2. Stephen Richmond1,
  3. Hashmat Popat1,
  4. Rebecca Playle1,
  5. Timothy Pickles1,
  6. Alexei I Zhurov1,
  7. David Marshall2,
  8. Paul L Rosin2,
  9. John Henderson3,
  10. Karen Bonuck4
  1. 1Applied Clinical Research & Public Health, Dental School, Wales, UK
  2. 2School of Computer Science & Informatics, Cardiff University, Wales, UK
  3. 3Avon Longitudinal Study of Parents and Children, University of Bristol, Bristol, UK
  4. 4Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
  1. Correspondence to Dr Ala Al Ali; alaa.alali{at}, dr.alaa97{at}


Objective To explore the relationship between the prevalence of sleep disordered breathing (SDB) and face shape morphology in a large cohort of 15-year-old children.

Design Observational longitudinal cohort study

Setting Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England.

Participants Three-dimensional surface laser scans were taken for 4784 white British children from the ALSPAC during a follow-up clinic. A total of 1724 children with sleep disordered breathing (SDB) and 1862 healthy children were identified via parents’ report of sleep disordered symptoms for their children. We excluded from the original cohort all children identified as having congenital abnormalities, diagnoses associated with poor growth and children with adenoidectomy and/or tonsillectomy.

Main outcome measures Parents in the ALSPAC reported sleep disordered symptoms (snoring, mouth breathing and apnoea) for their children at 6, 18, 30, 42, 57, 69 and 81 months. Average facial shells were created for children with and without SDB in order to explore surface differences.

Results Differences in facial measurements were found between the children with and without SDB throughout early childhood. The mean differences included an increase in face height in SDB children of 0.3 mm (95% CI −0.52 to −0.05); a decrease in mandibular prominence of 0.9° (95% CI −1.30 to −0.42) in SDB children; and a decrease in nose prominence and width of 0.12 mm (95% CI 0.00 to 0.24) and 0.72 mm (95% CI −0.10 to −0.25), respectively, in SDB children. The odds of children exhibiting symptoms of SDB increased significantly with respect to increased face height and mandible angle, but reduced with increased nose width and prominence.

Conclusions The combination of a long face, reduced nose prominence and width, and a retrognathic mandible may be diagnostic facial features of SBD that may warrant a referral to specialists for the evaluation of other clinical symptoms of SDB.

  • sleep disordered breathing
  • snoring
  • apnoea
  • mouth-breathing
  • three-dimensional imaging

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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