Is Ankyloglossia Correlated With Pediatric Sleep Disordered Breathing? A Systematic Review.

Objectives: Sleep disordered breathing (SDB) affects 2%-11% of children, predisposing them to neurobehavioral and developmental consequences. Ankyloglossia has been proposed as a risk factor for SDB, and frenotomy as a treatment for SDB in children with ankyloglossia. With increasing ankyloglossia diagnoses, it is critical to evaluate the evidence for a linkage between SDB and ankyloglossia.

Data sources: EMBASE, Web of Science, Medline, CINAHL, CCRCT, and SCOPUS were searched from inception to February 13, 2025. Publications assessing the relationship between ankyloglossia and SDB in non-syndromic children ages 0 to 18 years were included. Eight studies involving 1171 patients met inclusion criteria.

Review methods: Two reviewers independently screened abstracts and full texts for inclusion. Strength of clinical data was graded according to the Cochrane Risk of Bias Assessment and modified Newcastle-Ottawa Scale.

Results: There is mixed evidence of a relationship between ankyloglossia and pediatric SDB. The lack of standardized diagnostic criteria for ankyloglossia and the use of surveys instead of validated clinical assessment tools to assess SDB limit the generalizability of findings. There is also insufficient data to conclude that frenotomy is indicated in managing SDB in children with ankyloglossia. While two interventional studies report a positive association, their results have limited validity and generalizability.

Conclusion: There is an unclear relationship between ankyloglossia and pediatric SDB and insufficient evidence to determine if frenotomy is indicated as a treatment for SDB in children with ankyloglossia. Higher quality studies with standardized functional measures of ankyloglossia and validated assessment of SDB are needed.

Level of evidence: N/A.