BackgroundSleep Disordered Breathing (SDB) in children and its role in health has received renewed interest in the recent past. Malocclusion is one of the most common multifactorial craniofacial disturbances widely prevalent in children. The primary objective of this study was to assess the association of SDB with developing malocclusion in six to 12-year-old children and the effect of modifiers like age, gender, and tonsillar enlargement.Materials and methodOne hundred and seventy-seven children aged six to 12 years were assessed for developing malocclusion using Angle classification and Index of Orthodontic Treatment Needs (IOTN) comprising of 5 grades. Their parents were administered a pre-validated Pediatric Sleep Questionnaire (PSQ) for assessing SDB, by a single, calibrated examiner. The primary outcomes were SDB score, Angle class of malocclusion, and IOTN grade, assessed as categorical variables. The modifying variables assessed were age, gender, and tonsillar enlargement (Brodsky’s criteria). The data were subject to statistical analysis using Fischer’s test and the odds ratio (OR) was estimated. The modifiers were assessed using logistic regression.ResultsThe prevalence of SDB was 69%. SDB has significantly associated with angle class II and class III malocclusion (x2= 9.475, p < 0.05 OR=3.79) and with higher IOTN grades (x2= 109.799, p < 0.05, OR=53.64). Logistic regression revealed that gender and tonsillar enlargement had a significant modifying effect (p<0.05).ConclusionSDB had a significant association with developing malocclusion, the odds being higher in angle class II and III malocclusions and higher IOTN grades.Clinical relevanceBoth SDB and developing malocclusion are quite commonly seen in children, though the relation between the two has not been adequately explored. This study shows that they are strongly associated with each other and one could act as a marker for the other.