Pediatric Sleep Apnea: What the Research Says
Some children snore or breathe poorly during sleep. At its most serious, this is obstructive sleep apnea (OSA). Left untreated, it can affect behavior, attention, learning, and growth — so it’s worth taking seriously and bringing to your pediatrician’s attention.
Signs to mention to your pediatrician
- Snoring most nights
- Pauses, gasps, or snorts during sleep
- Restless sleep or unusual sleeping positions
- Frequent mouth breathing
- Daytime sleepiness, irritability, or trouble paying attention
Who diagnoses sleep apnea?
Only a physician can diagnose sleep apnea. The standard test is an overnight sleep study. Orthodontists and dentists can help by screening with a validated questionnaire and referring to a physician when there’s a concern. X-rays or 3D scans of the airway cannot diagnose sleep apnea or measure whether a treatment worked.
How is it treated?
It depends on how severe it is. For mild cases, doctors often start with nasal sprays and monitoring. When sleep apnea is more significant and the tonsils and adenoids are enlarged, removing them is the standard first-line treatment. Depending on the child, other options include treating allergies, CPAP, and healthy weight support.
What this means for young children
The American Association of Orthodontists recommends a first orthodontic checkup by age 7, or sooner if a problem is noticed. Many children seen at that age need no treatment yet — just monitoring. When early treatment is recommended, it should address a specific bite or jaw problem. If breathing is part of the concern, a physician’s diagnosis should come first.
Where orthodontics fits
The evidence that supports it
- In children who have both a narrow upper jaw and diagnosed sleep apnea, palatal expansion has improved sleep study results in the short term.
- The best results have come when expansion is combined with tonsil and adenoid removal.
- For children who still have sleep apnea after tonsil and adenoid removal and who also have a narrow upper jaw, expansion may help as a next step.
- Appliances that bring the lower jaw forward have shown small improvements in some studies.
The limits
- When expansion alone has been compared with control groups, it has not shown a significant improvement in sleep apnea.
- No orthodontic treatment has been shown to prevent sleep apnea, at any age.
- Orthodontic treatment is not recommended as a stand-alone treatment for sleep apnea.
- Sleep apnea often improves on its own as children grow. In one major trial, nearly half of children who were simply monitored no longer had sleep apnea seven months later.
- Frenectomy for tongue-tie is not recommended to prevent or treat sleep apnea. See our blog post about tongue-tie to learn more.
Good questions to ask any provider
- Has my child been evaluated by a physician for this?
- What specific problem with the teeth or jaws are you treating?
- What happens if we wait and monitor?
- How will we know if treatment worked? (Ask whether that means a sleep study, not a scan.)
Our approach at Parkside Orthodontics
If we notice signs of sleep-disordered breathing, or you tell us about concerns, we’ll refer your child to their pediatrician or an ENT for evaluation. If your child is diagnosed with sleep apnea and also has a jaw or bite problem, we work alongside your child’s physicians to decide whether orthodontic treatment can help. We recommend treatment only when there is a clear orthodontic need, and we’re always happy to talk through the evidence with you.
This post is for general education and isn’t a substitute for a physician’s evaluation. Updated September 2026.
Sources
- Palomo JM, et al. Sleep-disordered breathing and orthodontics. American Association of Orthodontists white paper update, Am J Orthod Dentofacial Orthop, 2026.
- Behrents RG, et al. Obstructive sleep apnea and orthodontics. American Association of Orthodontists White Paper, Am J Orthod Dentofacial Orthop, 2019.
- Marcus CL, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. American Academy of Pediatrics, Pediatrics, 2012.
- Nixon GM, et al. Intranasal treatments for children with sleep-disordered breathing: the MIST+ randomized clinical trial. JAMA Pediatrics, 2026.
- Bucci R, et al. Effect of orthopedic and functional orthodontic treatment in children with obstructive sleep apnea. Sleep Medicine Reviews, 2023.
- Yu M, et al. Orthodontic appliances for the treatment of pediatric obstructive sleep apnea. Sleep Medicine Reviews, 2023.
- Magalhães MC, et al. Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index in pediatric obstructive sleep apnea. Pediatric Pulmonology, 2024.
- Carvalho FR, et al. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database of Systematic Reviews, 2016.
- Bixler EO, et al. Natural history of sleep disordered breathing in prepubertal children transitioning to adolescence. European Respiratory Journal, 2016.
- Goodwin JL, et al. Incidence and remission of sleep-disordered breathing and related symptoms in 6- to 17-year-old children. Journal of Pediatrics, 2010.
- Marcus CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. New England Journal of Medicine, 2013.
- Messner AH, et al. Clinical consensus statement: ankyloglossia in children. Otolaryngology–Head and Neck Surgery, 2020.
- Thomas J, et al. Identification and management of ankyloglossia and its effect on breastfeeding in infants. American Academy of Pediatrics, Pediatrics, 2024.
- American Association of Orthodontists. Benefits of early orthodontics. aaoinfo.org.