A Systematic Review to Assess Swallowing Disorders in Paediatric Patients With Sleep-Disordered Breathing

Abstract

Introduction: Sleep-disordered breathing (SDB) affects up to 5% of children and is associated with multiple systemic complications. Recent concerns over rare but fatal choking incidents in children with untreated obstructive SDB (oSDB) have developed interest in whether swallowing dysfunction is a contributing factor. This systematic review investigates whether there is evidence linking paediatric oSDB with swallowing disorders, excluding children with known neurological or craniofacial comorbidities. Methods: A systematic literature search was conducted across Embase, PubMed, CINAHL, and Cochrane databases (11th November 2024), using PRISMA 2020 guidelines. Studies were included if they involved children with oSDB and reported swallowing assessments. Exclusion criteria included non-English publications, patients with syndromic or craniofacial conditions, and studies lacking primary data. The risk of bias was assessed using ROBINS-I. Results: Nine studies met the inclusion criteria. Reported prevalence of swallowing dysfunction ranged from 4% to 70%, with evidence of both oral-phase (e.g., atypical deglutition, reduced mastication) and pharyngeal-phase (e.g., choking, prolonged feeding) abnormalities. Outcome measures varied widely, with only two studies employing a validated swallowing tool. Three studies indicated that treatment of oSDB (adenotonsillectomy or myofunctional therapy) may improve swallowing symptoms. The quality of evidence was low, with most studies showing moderate to serious risk of bias. Conclusion: There is limited, low-quality evidence suggestive that children with oSDB are at increased risk of swallowing dysfunction. However, heterogeneity in definitions, assessment tools, and study design limits the ability to draw firm conclusions. Episodes of severe swallowing-related complications such as fatal aspiration or choking are rare but clinicians should consider swallowing issues in these patients. Further research with standardised, objective assessments is required to understand better the relationship between SDB and swallowing in children. Early evidence indicates that treated oSDB may improve swallow-related symptoms, but more studies are required before official practice recommendations. Overall, this systematic review highlights a possible link between oSDB and swallowing dysfunction emphasising the need for further objective research to guide clinical care for these patients.