Association between the habitual lip and tongue posture, clinical characteristics, and sleep-related problems in infants with Trisomy 21

Rezende, Gabriella Marra Guimarães; Fernandes, Ana Elisa Ribeiro; Silva, Anna Vitória Mendes Viana; Campos, Larissa Melgaço; Telson, Yasmim Carvalho; Motta, Andréa Rodrigues; Pretti, Henrique; Furlan, Renata Maria Moreira Moraes

doi:10.1590/2317-1782/e20240095pt

person Gabriella Marra Guimarães Rezende

conceptualization · data curation · formal analysis · writing original draft

schoolUniversidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.

0009-0003-0033-6567

person Ana Elisa Ribeiro Fernandes

formal analysis · writing review and editing

schoolDepartamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.

0000-0001-8358-4424

person Anna Vitória Mendes Viana Silva

formal analysis · writing review and editing

schoolPrograma de Pós-graduação em Odontologia, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.

0000-0002-1867-2126

person Larissa Melgaço Campos

data curation · formal analysis

schoolPrograma de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.

0009-0007-2571-376X

person Yasmim Carvalho Telson

formal analysis · writing review and editing

schoolPrograma de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.

0000-0002-3758-5247

person Andréa Rodrigues Motta

formal analysis · writing review and editing

schoolPrograma de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.schoolDepartamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.

0000-0002-1582-3785

person Henrique Pretti

formal analysis · writing review and editing

schoolDepartamento de Dentística Restauradora, Faculdade de Odontologia, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.

0000-0002-8309-5118

person Renata Maria Moreira Moraes Furlan

conceptualization · formal analysis · writing original draft · writing review and editing · supervision

schoolPrograma de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.schoolDepartamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.

0000-0001-7588-9316

Conflict of interests:

nothing to declare.

personCorrespondence address: Renata Maria Moreira Moraes Furlan Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG Av. Professor Alfredo Balena, 251, Santa Efigênia, Belo Horizonte (MG), Brasil, CEP: 30130-100. E-mail:
renatamfurlan@gmail.com

Variables	n	%
Prematurity
Yes	28	32.1
No	59	67.8
Pulmonary disease
Yes	6	6.9
No	81	93.1
Heart disease
Yes	53	60.9
No	34	39.1
Hypothyroidism
Yes	9	10.3
No	74	85.1
Under investigation	4	4.6
Breastfeeding
Yes	66	77.6
No	19	22.3
Not reported	2	2.3
Pacifier use
Yes	26	29.8
No	59	67.8
Not reported	2	2.3
Baby bottle use
Yes	61	70.1
No	24	27.6
Not reported	2	2.3
Choking
Yes	25	28.7
No	58	66.7
Not reported	4	4.6
Anterior food spillage
Yes	27	31.0
No	56	64.4
Not reported	4	4.6
Thumb sucking
Yes	25	28.7
No	60	69.0
Not reported	2	2.3
Habitual lip posture
Closed	2	5.0
Parted	16	40.0
Open	22	55.0
Habitual tongue posture
Contained in the oral cavity	20	50.0
Between the alveolar ridges	8	20.0
On the lips	12	30.0

BISQ variables	n	%
Sleep organization
Crib in a separate room	27	31.0
Crib in the parents’ room	42	48.3
Sleeping on the parents’ bed	12	13.8
Crib in the siblings’ room	4	4.6
Other	2	2.3
Most usual sleeping position
Prone	18	20.7
On the side	29	33.3
Supine	40	46.0
Mean sleep time
Less than 9 in 24 hours	3	3.4
9 or more in 24 hours	82	94.3
Not reported	2	2.3
Mean number of times they wake up per night
More than 3 nighttime awakenings	4	4.6
3 or fewer nighttime awakenings	83	95.4
Time spent awake at night
More than 1 hour	10	11.5
1 hour or less	71	81.6
Not reported	6	6.9
How they fall asleep
While eating	41	47.1
Being swayed	18	20.7
On the lap	10	11.5
By themselves in the crib	11	12.6
In bed near the parents	7	8.0
Time when they usually fall asleep at night
7:00 to 9:00 p.m.	50	58.1
9:01 to 11:00 p.m.	33	38.4
After 11:00 p.m.	3	3.5
Parents consider their child's sleep a problem
Yes	17	19.5
No	70	80.5

Variables	Never n (%)	Rarely n (%)	Occasionally n (%)	Almost always n (%)	Always n (%)	Unsure n (%)
How often does your child snore when they do NOT have a cold?	39 (44.8)	10 (11.5)	12 (13.8)	9 (10.3)	17 (19.5)	0
How often can you hear your child snoring from outside the room?	76 (87.4)	5 (5.7)	3 (3.4)	2 (2.3)	1 (1.1)	0
How often does your child struggle to breathe while sleeping?	67 (77.0)	6 (6.9)	7 (8.0)	4 (4.6)	3 (3.4)	0
How often does your child's breathing stop and they suddenly sigh?	51 (58.6)	13 (14.9)	11 (12.6)	5 (5.7)	5 (5.7)	2 (2.3)
When your child is sleeping, how often do you touch them to make them breathe again?	79 (90.8)	1 (1.1)	3 (3.4)	1 (1.1)	2 (2.3)	1 (1.1)
How often does your child sleep in unusual positions?	36 (41.4)	4 (4.6)	7 (8.0)	9 (10.3)	31 (35.6)	0
How often does your child have restless sleep?	33 (37.9)	8 (9.2)	8 (9.2)	3 (3.4)	35 (40.2)	0
How often does your child sweat while sleeping?	44 (50.6)	6 (6.9)	11 (12.6)	4 (4.6)	21 (24.14)	1 (1.1)
How often does your child wake up during the night? (More than other children the same age)	38 (43.7)	9 (10.3)	5 (5.7)	6 (6.9)	29 (33.3)	0
How often does your child have difficulty waking up in the morning, even after getting plenty of sleep?	70 (80.5)	4 (4.6)	2 (2.3)	1 (1.1)	10 (11.5)	0
How often is your child grumpy soon after waking up?	71 (81.6)	0	2 (2.3)	2 (2.3)	11 (12.6)	1 (1.1)
How often does your child tend to breathe through their mouth during the day?	26 (29.9)	8 (9.2)	13 (14.9)	2 (2.3)	37 (42.5)	1 (1.1)
How often is your child unusually sleepy during the day?	68 (78.2)	4 (4.6)	3 (3.4)	2 (2.3)	10 (11.5)	0
How often does your child seem more hyperactive or restless than other same-age children?	76 (87.4)	2 (2.3)	1 (1.1)	1 (1.1)	7 (8.0)	0

Variables	Sleep quality		p-value
Variables	Good	Poor	p-value
Sex
Males	35	10	0.203
Females	37	5	0.203
Prematurity
Yes	22	6	0.476
No	50	9	0.476
Pulmonary disease
Yes	4	2	0.279
No	68	13	0.279
Heart disease
Yes	43	10	0.616
No	29	5	0.616
Hypothyroidism
Yes	8	1	0.544
No	60	14	0.544
Breastfeeding
Yes	54	12	0.810
No	16	3	0.810
Pacifier use
Yes	20	6	0.549
No	50	9	0.549
Baby bottle use
Yes	47	14	0.096
No	23	1	0.096
Choking
Yes	19	6	0.484
No	50	8	0.484
Anterior food spillage
Yes	21	6	0.612
No	48	8	0.612
Thumb sucking
Yes	19	6	0.490
No	51	9	0.490
Habitual lip posture
Closed	2	0	0.755
Parted	13	3
Open	19	3
Habitual tongue posture
Contained in the oral cavity	17	3	0.071
Between the alveolar ridges	5	3
On the lips	12	0

Variables	Snoring		p-value	Respiratory pause		p-value	Unusual position		p-value	Restless sleep		p-value
Variables	Yes	No	p-value	Yes	No	p-value	Yes	No	p-value	Yes	No	p-value
Sex
Males	16	29	0.345	5	38	0.968	15	30	0.014*	16	29	0.114
Females	11	31	0.345	5	37	0.968	25	17	0.014*	22	20	0.114
Prematurity
Yes	12	16	0.081	6	21	0.041*	11	17	0.388	11	17	0.569
No	22	37	0.081	4	54	0.041*	29	30	0.388	27	32	0.569
Pulmonary disease
Yes	26	55	0.430	0	6	0.354	3	3	0.838	3	3	0.746
No	1	5	0.430	10	69	0.354	37	44	0.838	35	46	0.746
Heart disease
Yes	14	39	0.245	6	46	0.935	23	30	0.546	23	30	0.947
No	13	21	0.245	4	29	0.935	17	17	0.546	15	19	0.947
Hypothyroidism
Yes	5	4	0.580	1	8	0.750	5	4	0.594	4	5	0.743
No	32	42	0.580	9	63	0.750	34	40	0.594	33	41	0.743
Breastfeeding
Yes	22	44	0.306	10	54	0.066	28	38	0.233	29	37	0.887
No	4	15	0.306	0	19	0.066	11	8	0.233	8	11	0.887
Pacifier use
Yes	4	22	0.103	4	22	0.528	14	12	0.328	13	13	0.424
No	22	37	0.103	6	51	0.528	25	34	0.328	24	35	0.424
Baby bottle use
Yes	19	42	0.858	6	54	0.355	30	31	0.331	28	33	0.482
No	7	17	0.858	4	19	0.355	9	15	0.331	9	15	0.482
Choking
Yes	5	20	0.187	1	22	0.223	8	17	0.130	6	19	0.019*
No	20	38	0.187	8	50	0.223	29	29	0.130	30	28	0.019*
Anterior food spillage
Yes	10	17	0.340	4	21	0.350	13	14	0.650	9	18	0.200
No	15	41	0.340	5	51	0.350	24	32	0.650	27	29	0.200
Thumb sucking
Yes	5	20	0.171	3	22	0.993	12	13	0.800	8	17	0.166
No	21	39	0.171	7	51	0.993	27	33	0.800	29	31	0.166
Habitual lip posture
Closed	1	1	0.775	1	1	0.394	1	1	0.644	0	2	0.457
Parted	5	11		2	12		9	7		7	9
Open	9	13		3	19		9	13		10	12
Habitual tongue posture
Contained in the oral cavity	8	12	0.713	2	17	0.093	11	9	0.024*	8	12	0.887
Between alveolar ridges	2	6		3	4		6	2		4	4
On the lips	5	7		1	11		2	10		5	7

[1] Caption: n = absolute frequency; % = relative frequency