Towards a better diagnosis of mouth breathing: validity and reliability of a protocol for assessing the awake breathing pattern in preschool children

TL;DR

This study validates a new method for diagnosing mouth breathing in young children using a clinical tool and CO2 sensor measurements.

Contribution

The study introduces a reliable and valid protocol for assessing breathing patterns in preschool children.

Findings

The ABPA tool can reliably distinguish between nasal and mouth breathing in preschool children.

The ABPA showed good specificity and fair sensitivity when compared to CO2 sensor measurements.

A CO2-based reference tool was successfully used for the first time in children to assess breathing patterns.

Abstract

The Awake Breathing Pattern Assessment (ABPA) is a prototypical clinical grid recently designed through an international consensus of Speech and Language Pathologists (SLPs) to categorize the awake and habitual breathing pattern during the orofacial myofunctional assessment. This cross-sectional study aims to explore the psychometric properties of the ABPA in a preschool population.

133 children from 2;11 to 6 years old were assessed with the ABPA. The percentage of time spent breathing through the mouth was objectively measured by a CO2 sensor and used as a baseline measurement. We first performed a multivariate Latent Profile Analysis based on the CO2 measurement and a parental questionnaire to define the number of categories that best characterize the breathing pattern. Subsequently, we assessed the intra- and inter-rater reliability, internal consistency criterion validity, construct validity and sensitivity and specificity.

The awake breathing pattern can best be described by two groups: nasal and mouth breathing. The ABPA, initially designed in three groups, was adjusted accordingly. This final version showed excellent intra-rater and inter-rater reliability. There was a significant correlation between the ABPA and the CO2 measurement. The ABPA showed a fair sensitivity and a good specificity.

The reference tool based on CO2 data was used in children for the first time and was found to be reliable. The ABPA is a suitable tool for SLPs to confirm the diagnosis of mouth breathing in preschool children if more sensitive screening tools, like parental questionnaires, are used beforehand.

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