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

Aim Paediatric sleep breathing disorders represent an emerging paediatric health concern. Despite risk factors are widely discussedin literature, evidences about protective factors are lacking. The aimof this systematic review was to examine the available evidenceabout the effect of breastfeeding on snoring and obstructive sleepapnea in childhood, and to methodically describe the underlyingmechanism of interaction.Methods The study protocol was registered in advance inPROSPERO (CRD42020212529). Electronic search of the literaturewas performed up to October 10th, 2020 using four databases:PubMed, ScienceDirect, Medline and Scopus. Two authorsindependently retrieved potentially relevant articles to meeteligibility criteria. PRISMA guidelines were followed. Prospective,retrospective, case-control, cohort, clinical trial and cross-sectionalstudies investigating the association between breastfeeding andpaediatric sleep-disordered breathing were included and data wereextracted. No restrictions on language or date of publication wereset. Subsequently, a search in the literature was further done toinvestigate underlying mechanisms of interaction.Results Fifteen studies were included. The evidence supports aprotective dose-response effect of breastfeeding on sleep breathingdisorders in children and adolescents. Exclusive breastfeedingemerged to prevent habitual snoring when compared to formulafedor non-breastfed children. Breastfeeding promotes harmoniousdevelopment of oral cavity, trains oral muscles and tongue posture,coordinates nose breathing and prevents adenotonsillar hypertrophy.Conclusions This review suggests that breastfeeding caneffectively protect children and adolescents from sleep-disorderedbreathing, especially from habitual snoring, by preventing theassociated risk factors.