The orthodontic landscape is evolving beyond occlusion and aesthetics, expanding into realms that intersect with systemic health most notably, the airway. This review explores a compelling paradigm shift: the growing body of evidence that links malocclusion with sleep-disordered breathing, particularly obstructive sleep apnea (OSA). No longer viewed in isolation, craniofacial architecture and dental arch relationships are now recognized as potential contributors to compromised airway volume and function. We synthesize current literature to unravel how sagittal and vertical dysmorphologies—such as retrognathic mandibles, narrow maxillary arches, and deep bites correlate with reduced upper airway dimensions and increased risk of airway obstruction during sleep. Furthermore, this review investigates how orthodontic interventions, including maxillary expansion, mandibular advancement, and functional appliance therapy, may influence airway patency. Rather than presenting orthodontics as a cure for OSA, we critically evaluate the extent to which treatment timing, modality, and individual growth patterns determine outcomes. We also spotlight the need for interdisciplinary synergy between orthodontists, sleep physicians, and ENT specialists, advocating for a patient-centred, airway-conscious approach in diagnosis and treatment planning. While the evidence is promising, we emphasize the gaps that persist especially in longitudinal outcomes and standardization of airway assessment protocols. In rethinking malocclusion through the lens of airway health, this review calls for a new orthodontic responsibility: not merely aligning teeth, but potentially aiding in breath, sleep, and systemic wellness. The implications are profound not only for orthodontic strategy but also for the very definition of oral health.