{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:21:47Z","timestamp":1785763307825,"version":"3.56.0"},"reference-count":47,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Sleep-disordered breathing (SDB), including obstructive sleep apnea, is common in children and is associated with mouth breathing, snoring, and neurobehavioral disturbances. In pediatric orthodontic patients, oral habits and craniofacial imbalances may contribute to airway dysfunction, making orthodontic evaluation a potential setting for early identification of SDB. This study aimed to estimate the prevalence of SDB and to evaluate its associations with parent-reported behavioral symptom profiles in a cohort of pediatric orthodontic patients. Methods: A multicenter cross-sectional study was conducted in 186 children aged 7\u201313 years attending orthodontic clinics in Oradea and T\u00e2rgu Mure\u0219, Romania. Parents completed a structured questionnaire on oral habits, the 22-item Pediatric Sleep Questionnaire (PSQ), with SDB defined as 8 or more positive responses, and a parent-reported behavioral screening form assessing ADHD symptom subtypes, oppositional-defiant disorder (ODD), conduct disorder, and anxiety\/depression. These behavioral outcomes were based on screening measures and were not intended as clinical psychiatric diagnoses. Associations were analyzed using chi-square or Fisher\u2019s exact tests, and multivariable logistic regression analyses were performed adjusting for age, sex, and weight status. Results: Mouth breathing was reported in 61.8% of participants, snoring in 26.9%, and SDB in 13.4%. Positive screens for ADHD-inattentive (p &lt; 0.001), ADHD-hyperactive\/impulsive (p &lt; 0.001), ADHD-combined (p &lt; 0.001), ODD (p &lt; 0.001), and anxiety\/depression (p &lt; 0.001) were significantly more frequent among children with SDB. In multivariable analysis, SDB remained independently associated with ADHD-combined subtype (OR = 6.22), ADHD-hyperactive\/impulsive symptoms (OR = 5.84), oppositional-defiant disorder (OR = 4.91), and anxiety\/depression (OR = 4.38). Conclusions: SDB was identified in a meaningful proportion of pediatric orthodontic patients and was significantly associated with multiple screening-defined behavioral symptom domains. These findings support consideration of brief airway- and sleep-oriented screening during orthodontic assessment, particularly in school-aged children presenting with mouth breathing, snoring, or behavioral concerns. Given the cross-sectional and questionnaire-based design, the findings should be interpreted as associative and warrant confirmation in prospective studies using objective sleep measures.<\/jats:p>","DOI":"10.3390\/jcm15093386","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:46:11Z","timestamp":1777455971000},"page":"3386","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sleep-Disordered Breathing and Behavioral Symptoms in Pediatric Orthodontic Patients: A Multicenter Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0339-2831","authenticated-orcid":false,"given":"Valeriu Mihai","family":"But","sequence":"first","affiliation":[{"name":"Department of Medicine-Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorana Nicoleta","family":"Ro\u0219u","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Grigore T. Popa University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2943-4745","authenticated-orcid":false,"given":"Cristina-Ioana","family":"Bica","sequence":"additional","affiliation":[{"name":"Department of Pedodontics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, Gh Marinescu 38, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3883-0547","authenticated-orcid":false,"given":"Alexandru","family":"Vlasa","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 38 Gh. Marinescu Str., 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana-Maria","family":"Coman","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 38 Gh. Marinescu Str., 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4108-3097","authenticated-orcid":false,"given":"Clara Diana","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, Grigore T. Popa University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1665-3239","authenticated-orcid":false,"given":"Alexandra Mihaela","family":"Stoica","sequence":"additional","affiliation":[{"name":"Department of Odontology and Oral Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Pacurar","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 38 Gh. Marinescu Str., 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Elsaafin","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 38 Gh. Marinescu Str., 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Brockmann, P.E., and Gozal, D. (2022). Neurocognitive consequences in children with sleep-disordered breathing: Who is at risk?. Children, 9.","DOI":"10.3390\/children9091278"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zhang, W., Shen, Y., Ou, X., Wang, H., and Liu, S. (2024). 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