Dynamics of salivary stress-related biomarkers in children with malocclusion and risk for sleep problems and sleep-disordered breathing: a cross-sectional study.

INTRODUCTION

Sleep problems in children can affect neuroendocrine regulation and craniofacial development. Although malocclusion may contribute to airway impairment and altered growth patterns, the associations between sleep-related symptoms and physiological stress markers remain unclear. This study examined salivary stress-related biomarkers and craniofacial morphology in children with malocclusion who were at elevated risk for sleep problems and sleep-disordered breathing (SDB).

MATERIALS AND

METHODS

Seventy-five children aged 7-12 years completed the Japanese Sleep Questionnaire for Elementary Schoolers (JSQ-ES). Children with total scores ≥80 were classified as high risk for general sleep problems, and those with SDB subscale scores ≥10 as high risk for SDB. Unstimulated saliva was analysed for oxytocin, melatonin, cortisol, and chromogranin A. Lateral cephalograms were evaluated for 34 variables. Statistical analyses included Shapiro-Wilk, t-tests or Mann-Whitney U-tests, and Pearson's or Spearman's correlations (P < .05).

RESULTS

Fourteen children (18.7%) were classified as high risk for general sleep problems and 38 (50.7%) as high risk for SDB. Oxytocin concentration was lower in the high-risk sleep problems group (P = .041) and correlated negatively with JSQ-ES total score (ρ = -0.250). No biomarker differences were observed by SDB risk. Children at high risk for sleep problems showed a greater mandibular plane angle, while higher SDB scores were associated with anteroposterior skeletal discrepancies.

CONCLUSIONS

Children at elevated risk for general sleep problems showed reduced salivary oxytocin and greater vertical skeletal divergence, whereas those at elevated SDB risk exhibited anteroposterior craniofacial differences without biomarker alterations.