Pediatric Sleep and Breathing

Video Presentations: Learn about our multidisciplinary approach to pediatric sleep and breathing problems by watching these two lectures in which Dr. Zaghi explains the importance of exclusive nasal breathing and ideal tongue-posture to optimizing maxillofacial development, as well as overall health and well-being. 

Summary:   Snoring is not a normal behavior. Healthy nighttime sleep breathing consists of quiet nasal breathing with the lips closed and the tongue resting all the way up at the roof of the mouth. 


A case study is presented of a 27-year-old male with a history of ADHD-like symptoms as a child, who developed progressively worsening snoring to the point that he developed very severe sleep apnea. In order to treat his condition, a MMA (Maxillary Mandibular Advancement Surgery) was performed to open up his airway and bring forward his jaws. The surgery was a success and cleared a lot of the issues he had been facing with sleepiness, fatigue, breathing, anxiety, depression, concentration, and attention. The case raises the importance for early diagnosis and treatment.


Mouth breathing and effortful breathing are one of the earliest signs of sleep-disordered breathing and eventually sleep apnea. The many potential consequences of untreated pediatric sleep disordered breathing (including behavioral and learning issues as well as overall health and wellness) are reviewed.  Observation and awareness of sleep and breathing habits are key to early diagnosis.


Dr. Zaghi describes a series of tests that are available in order to assess for the presence of sleep apnea. However, many of these tests for children are limited because they focus primarily on oxygen levels rather than arousals from sleep and compensations for airway restrictions. Most patients present with mouth breathing or noisy breathing that are consistent with sleep-disordered breathing, whereas only a handful patients actually present with signs of oxygen loss or breathe holding severe enough to be formally diagnosed with Obstructive Sleep Apnea. The goal of evaluation and treatment at the Breathe Institute is to address issues when they are considered "mild" before they become severe. 

Dr. Zaghi  then provides an overview of a multidisciplinary treatment protocol for Pediatric Sleep-Disordered Breathing that includes myofunctional therapy (as the first option), medical management, surgery, dental treatment, and CPAP (only as a last resort). He emphasizes the effectiveness of myofunctional therapy and reviews recent literature that underscores the critical importance of continuous nasal breathing as the ultimate goal in the treatment of pediatric sleep-disordered breathing. 

Interview: Make sure your child doesn't have a sleep disorder before they go back to school #SleepExpert Dr. Zaghi taking questions! 💤💙👶🛌
Case Study: Madelyn - 3 year-old girl with sleep-disordered breathing, swallow, and speech issues treated with myofunctional therapy and minor surgical procedure (tongue-tie and lip-tie release)
Case Study:  Tyler - 8 year old boy with a history of snoring and mouth breathing associated with grinding the teeth, stopping breathing during sleep, gasping/waking with a startle, sleeping in odd positions, difficulty getting to sleep, difficulty staying asleep, fidgety legs, and frequent nightmares. He has trouble focusing and concentrating in school and appears hyperactive during the day.  Treatment: Tonsillectomy. 
Case Study:  Trevor- 23 year-old man with a long history of tongue-tie contributing to tightness in his neck, head, and shoulders that is worse with breathing and talking. He has a history of TMJ pain, clicking, and dysfunction. He reports trouble falling asleep and prefers to sleep on his side. He says that it is impossible for him to sleep lying flat on his back and experiences anxiety/depression due to issues with chronic fatigue.  He has had a history of tonsillectomy and incomplete prior frenectomy as well as orthodontics with maxillary expansion. Prior to the orthodontics, he had recurrent sinus infections that have improved since that time.  Treatment: Tongue-tie release (myofunctional therapy + lingual frenuloplasty). 
Case Study:  Nomi- 8-year-old girl with a long history of mouth breathing, snoring, and sleep issues. There is a history of restless sleep, waking up at night, mouth breathing, nightmares, snoring during sleep, anxiety, behavioral issues, sleepy during the day, mouth open messy eating. She has a history of tongue-thrust and speech impediment.  Treatment: Posterior tongue-tie release. 
Case Study: Thomas- 10-year-old boy with snoring, open mouth breathing, and difficulty breathing through the nose. He has a history of environmental and seasonal allergies and is often sick with colds or other infections. He is a restless sleeper and moves around a lot during the night. He also presents for evaluation of facial tics including grimacing of the left orbit and flaring of the nostrils. These habitual spasms occur in intervals of 5-10 times per minute and significantly affect his quality-of-life. Treatment: Myofunctional therapy (Joy Moeller),  posterior tongue-tie release (Dr. Zaghi), and orthodontic maxillary expansion (Dr. William Hang)

Hall of Fame -- Super Star Patients