Breastfeeding and sleep-disordered breathing in children: systematic review and proposal of underlying interaction models

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ABSTRACT

Aim

Paediatric sleep breathing disorders represent an emerging paediatric health concern. Despite risk factors are widely discussed in literature, evidences about protective factors are lacking. The aim of this systematic review was to examine the available evidence about the effect of breastfeeding on snoring and obstructive sleep apnea in childhood, and to methodically describe the underlying mechanism of interaction.

Methods

The study protocol was registered in advance in PROSPERO (CRD42020212529). Electronic search of the literature was performed up to October 10th, 2020 using four databases: PubMed, ScienceDirect, Medline and Scopus. Two authors independently retrieved potentially relevant articles to meet eligibility criteria. PRISMA guidelines were followed. Prospective, retrospective, case-control, cohort, clinical trial and cross-sectional studies investigating the association between breastfeeding and paediatric sleep-disordered breathing were included and data were extracted. No restrictions on language or date of publication were set. Subsequently, a search in the literature was further done to investigate underlying mechanisms of interaction.

Results

Fifteen studies were included. The evidence supports a protective dose-response effect of breastfeeding on sleep breathing disorders in children and adolescents. Exclusive breastfeeding emerged to prevent habitual snoring when compared to formula-fed or non-breastfed children. Breastfeeding promotes harmonious development of oral cavity, trains oral muscles and tongue posture, coordinates nose breathing and prevents adenotonsillar hypertrophy.

Conclusion

This review suggests that breastfeeding can effectively protect children and adolescents from sleep-disordered breathing, especially from habitual snoring, by preventing the associated risk factors. Future prospective studies with more efficient design are required.

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