Cephalometric risk factors of obstructive sleep apnea (original) (raw)
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Obstructive sleep apnea (OSA) is one of the common sleep breathing disorders in adults, characterised by frequent episodes of upper airway collapse during sleep. Craniofacial disharmony is an important risk factor for OSA. Overnight polysomnography (PSG) study is considered to be the most reliable confirmatory investigation for OSA diagnosis, whereas the precise localization of site of obstruction to the airflow cannot be detected. Identifying the cause of OSA in a particular ethnic population/individual subject helps to understand the etiological factors and effective management of OSA. The objective of the meta-analysis is to elucidate altered craniofacial anatomy on lateral cephalograms in adult subjects with established OSA. Significant weighted mean difference with insignificant heterogeneity was found for the following parameters: anterior lower facial height (ALFH: 2.48 mm), position of hyoid bone (Go-H: 5.45 mm, SeH: 6.89 mm, GoGn-H: 11.84 , GoGn-H: 7.22 mm, NeSeH: 2.14), and pharyngeal airway space (PNS-Phw: À1.55 mm, pharyngeal space: À495.74 mm 2 and oro-pharyngeal area: À151.15 mm 2). Significant weighted mean difference with significant heterogeneity was found for the following parameters: cranial base (SN: À2.25 mm, SeNeBa: À1.45), position and length of mandible (SNB: À1.49 and Go-Me: À5.66 mm) respectively, maxillary length (ANS-PNS: À1.76 mm), tongue area (T: 366.51 mm 2), soft palate area (UV: 125.02 mm 2), and upper airway length (UAL: 5.39 mm). This metaanalysis supports the relationship between craniofacial disharmony and obstructive sleep apnea. There is a strong evidence for reduced pharyngeal airway space, inferiorly placed hyoid bone and increased anterior facial heights in adult OSA patients compared to control subjects. The cephalometric analysis provides insight into anatomical basis of the etiology of OSA that can influence making a choice of appropriate therapy.
A cephalometric comparison of subjects with snoring and obstructive sleep apnoea
The European Journal of Orthodontics, 2000
This prospective study analysed the upright lateral cephalometric radiographs of 115 dentate, Caucasian males. Forty-five subjects exhibited proven obstructive sleep apnoea (OSA), 46 were simple snorers, and the remaining 24 subjects, who had no history of respiratory disease and did not snore, acted as controls. Radiographs were traced and digitized, and comparisons were made of the dento-skeletal, soft tissue, and oropharyngeal features of the three groups. Differences were also sought between the snoring and OSA subjects. Of the hard tissue measurements, only the cranial base angle and mandibular body length showed significant inter-group differences (P < 0.001 and P < 0.05, respectively). When the airway and associated structures were examined, both snorers and OSA subjects exhibited narrower airways, reduced oropharyngeal areas, shorter and thicker soft palates, and larger tongues than their control counterparts. Comparison of the two sleep disordered breathing groups showed no differences in any of the skeletal or dental variables examined. However in OSA subjects, the soft palate was larger and thicker (P < 0.05), both lingual and oropharyngeal areas were increased (P < 0.01 and P < 0.05, respectively) and the hyoid was further from the mandibular plane (P < 0.05). Thus, whilst the dento-skeletal patterns of snorers resembled those of subjects with OSA, some differences in soft tissue and hyoid orientation were apparent. There was not, however, a recognizable gradation in size of the airway and its associated structures from control through snoring to OSA subjects. This suggests that there may be a cephalometrically recognizable predisposition towards the development of sleep disordered breathing, but that this is only one facet of the condition.
The influence of craniofacial structure on obstructive sleep apnea in young adults
Journal of Oral and Maxillofacial Surgery, 1998
This study compares craniofacial measurements of lateral cephalometric radiographs of young obstructive sleep apnea patients with those of nonapneic snorers and controls. Patients and Methods: Forty-eight patients (BMI = 28.0-+ 3.8) with obstructive sleep apnea, 25 patients (BMI = 26.3 + 3.5) with nonapneic snoring, and 54 controls (BMI = 24.8 + 2.7) were evaluated. All subjects were between 18 and 40 years of age. Nineteen lateral cephalometric measurements were performed by a single investigator blinded to the results of the polysomnograms. Results: Univariate logistic regression analysis of the 19 variables showed significantly increased midfacial height (AN!+N), narrowed middle airway space (MAS), steep mandibular plane angle (IMA), elongated pharynx (PNS-Eb), and inferiorly positioned hyoid bone (PNS-H, MPH) in the obstructive sleep apnea group. The nonapneic snoring group showed only a tendency toward maxillary and mandibular retrognathia (SNA and SNB). No significant differences were found for cranial base angle (S-N-Ba), PAS, inferior airway space, maxillary unit length (ANS-PNS) mandibular unit length (Cd-Gn), tongue height (Trig-Ht), soft palate length (PNS-P), and palatal vault height (Ocl-Pa16). The OSA group was also found to have multiple sites of abnormality of both the upper and lower pharynx, with 58% of the patients having two or more abnormal values (1 standard deviation from the mean) as opposed to 40% of the nonapneic snoring group. Conclusions: Highly significant craniofacial abnormalities were found in the upper and lower pharynx in young obstructive sleep apnea patients. Most of these patients (58%) had abnormalities in both the upper and lower pharynx, suggesting that palatal surgery alone may be an inadequate treatment. This information may define future investigations needed to determine how to more effectively treat this subgroup of young obstructive sleep apnea patients. Obstructive sleep apnea (OSA) is a disorder in which recurrent closure of the upper airway occurs during sleep. Arousal from sleep is required to reopen the obstructed airway. These frequent arousals are the
Turkish Journal of Medical Sciences
Aim: To evaluate the cephalometric features of patients with obstructive sleep apnea syndrome (OSAS) and to elucidate the relationship between the severity of OSAS and cephalometric and clinical variables. Materials and methods: Ninety-three patients (71M/22W) with OSAS were classified into 3 subgroups according to the apnea-hypopnea index (AHI). Various cephalometric and clinical measurements were carried out for all patients. Results: Inferior airway space (IAS), maximum soft palate thickness (MSPT), SNGoGn degrees, and distance of hyoid bone to mandibular plane (Hy-MPPerp) were found to be higher in severe OSAS for both sexes. Middle airway space, IAS, MSPT, and Hy-MPPerp were correlated positively with AHI; however, superior airway space (SAS) was correlated negatively. In the stepwise regression analysis, mean SaO2, neck circumferences for men, and mean SaO2 and uvula length (PNS-PA) for women were included in the model to estimate AHI properties. Conclusion: The values of IAS,...
Cephalometric analysis for the diagnosis of sleep apnea
2013
To verify if the reference values of Sleep Apnea cephalometric analysis of North American individuals are similar to the ones of Brazilian individuals presenting no craniofacial anomalies. The study also aimed to identify craniofacial alterations in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) patients in relation to individuals without clinical characteristics of the disease through this cephalometric analysis. Method: It were used 55 lateral cephalograms consisting of 29 for the control group of adult individuals without clinical characteristics of OSAHS and 26 apneic adults. All radiographs were submitted to Sleep Apnea cephalometric analysis through Radiocef Studio 2.0. The standard values of this analysis were compared, by means of z test, to the ones obtained from the control group and these were compared to values from apneic group through Student's t test. Results: There were no significant differences between values obtained from control group and standard values. On the group of OSAHS patients it was observed a decrease on the dimensions of upper airways and an increase on the soft palate length. Conclusions: The standard values of Sleep Apnea analysis can be used as reference in Brazilian individuals. Besides, through lateral cephalograms it was possible to identify craniofacial alterations in OSAHS patients.
Medicina
Background and Objectives: To determine whether there are changes in the cephalometric characteristics of the upper airways and hyoid bone, in patients diagnosed with obstructive sleep apnea syndrome (OSAS) compared to a healthy control group. Material and Methods: This retrospective case–control study included 24 patients diagnosed with OSAS (apnea–hypopnea index (AHI) > 5 obtained after polysomnography) and 24 healthy subjects as a control group that completed the STOP-Bang questionnaire to determine whether they had OSAS. Lateral cephalometric examinations were recommended for all these patients. The software used for the cephalogram interpretation was CS 3D Imaging and CS Airway imaging from Carestream Dental. Results: The subjects with OSAS had a smaller superior posterior airway space (SPAS), with an average of 10.32 mm compared to a 12.20 mm mean in the control group (p = 0.03). Patients with OSAS, had a lowered middle airway space (MAS) with a mean of 7.96 mm in the OSAS ...
Contribution of postero-anterior cephalometry in obstructive sleep apnea
The Laryngoscope, 2012
Objectives/Hypothesis: Lateral cephalometry has been widely used to characterize facial and maxillary morphology in obstructive sleep apnea (OSA) patients. It is a useful tool to assess orthodontic and maxillofacial procedures, but transverse dimensions of the airway (e.g., nasal framework) have not been well described yet by cephalometry. We explored whether postero-anterior cephalometry could refine the analysis of the facial morphology, with a special attention paid to nasal morphology. We validated cephalometric measurements relevant to the diagnosis of OSA. Study Design: Controlled study. Methods: We explored postero-anterior and lateral cephalometric bony structures in OSA patients and in control subjects to determine which were predictive of an association with OSA. Healthy volunteers paired for age and sex to OSA patients underwent polysomnography and cephalometry. Data were analyzed by Shapiro-Wilk, Fisher, Wilcoxon, and paired t tests where appropriate. Results: Nasal fossae and maxillary bone proportions were positively and independently associated with the absence of OSA. Measurements of maxillary width, nasal fossae angle, and anterior skull base contributed to the characterization of OSA patients. Conclusions: Postero-anterior cephalometry is an easy, rapid, informative, and reliable technique, which is complementary to the lateral cephalometry in the assessment of OSA patients. Our study may also suggest the negative impact of the nasal resistance on the upper airway resistance in sleep disorders.
Local Anatomical Factors Predisposing to Obstructive Sleep Apnea: A Review
SciDoc publishers, 2021
Obstructive sleep apnea (OSA) is a condition that is characterized by collapse of the pharyngeal airway resulting in repeated episodes of airflow cessation, oxygen desaturation, and sleep disruption during the course of night. Obstructive sleep apneahypopnea syndrome (OSAHS) is characterized by repetitive episodes of airflow reduction (hypopnea) or cessation (apnea) due to upper airway collapse during sleep. OSA is classified as mild, moderate or severe. Patients with OSA have excessive daytime sleepiness, and may develop systemic hypertension, right heart failure, and cardiac arrhythmias. The interaction between local or general anatomic factors are important in mediating airway size and may have a strong impact on the development of OSA. Various local anatomical factors that can have an impact on the upper airway and predisposing to OSA are the craniofacial bony factors and soft tissue factors. Craniofacial bony anatomical factors include the mandible and the hyoid bone. Soft tissue factors include tongue, uvula, soft palate, tonsils and lateral pharyngeal wall. This article discusses in detail the various local anatomic factors predisposing to OSA. It is very evident from this review that various local anatomic factors play a role in the development of Obstructive Sleep Apnea.