Craniofacial morphology in patients with obstructive sleep apnea: cephalometric evaluation

Assessment of cephalometric parameters and correlation with the severity of the obstructive sleep apnea syndrome

BACKGROUND

In individuals diagnosed with obstructive sleep apnea syndrome (OSAS), variations in craniofacial structure have been inconsistently documented, showing differing degrees of alteration between obese and nonobese patients. In addition, sleep disturbance has also been shown to induce disequilibrium in this population of patients. This pilot observational study aimed to assess craniofacial values in obese and nonobese subpopulations of patients with OSAS and their correlation and association with the severity of OSAS. We also assessed whether OSAS patients are characterized by an impaired equilibrium in relation to and associated with the severity of OSAS.

METHODS

We included all consecutive adult patients with OSAS. Through cephalometry, we assessed the upper (UPa-UPp) and lower (LPa-LPp) pharynx diameters, superior anterior facial height (Sor-ANS), anterior facial height (ANS-Me), anterior vertical dimension (Sor-Me), posterior facial height (S-Go) and craniovertebral angle (CVA). Furthermore, we analyzed postural equilibrium through a stabilometric examination.

RESULTS

Forty consecutive OSAS patients (45% female with a mean age of 56 ± 8.2 years) were included. The subgroup of nonobese patients had a reduced UPa-UPp (p = 0.02). Cephalometric measurements were correlated with the severity of OSAS in nonobese patients, whereas only Sor-ANS was correlated with the severity of OSAS in the obese subpopulation. In the overall population, altered craniofacial values are associated with severe OSAS. Although there are differences in equilibrium between obese and nonobese OSAS patients, the stabilometric measurements were not correlated or associated with OSAS severity.

CONCLUSION

Altered craniofacial values and compromised equilibrium in OSAS patients are linked to OSAS severity. Therefore, the management of OSAS should be tailored not only to weight management but also to craniofacial and postural rehabilitation to enhance patient outcomes.

Cephalometric Evaluation in Patients with Obstructive Sleep Apnea undergoing Lateral Pharyngoplasty

Introduction  Lateral pharyngoplasty (LP) has shown promising results. Craniofacial deformity reduces the pharyngeal space, contributing to the etiopathogenesis. The analysis of craniofacial features can be performed using cephalometry. Objective  To verify if craniofacial deformity is associated with worse polysomnographic data in patients with obstructive sleep apnea (OSA), and to verify if the preoperative cephalometric parameters can interfere with the surgical success of the LP. Methods  The study included 21 patients with OSA aged between 18 and 65 years who underwent LP in a university hospital from 2015 to 2019. Polysomnography was performed postoperatively, after a minimum period of 6 months from the surgical procedure. In addition, a cephalometric evaluation was performed to assess craniofacial deformity, and to correlate it with the polysomnographic results. Results  The mean and median of all polysomnographic respiratory parameters improved postoperatively, especially the apnea-hypopnea index (AHI), which went from 40.15 to 16.60 events per hour ( p  = 0.001). Of the 21 patients, 15 showed improvements in the AHI postoperatively. As for the cephalometric evaluations, we found that the longer the distance between the hyoid bone and the mandibular plane, the greater the patient's preoperative AHI ( p  = 0.011). When assessing whether cephalometric changes related to craniofacial deformities influence the surgical outcome of LP, no correlation was found for any cephalometric measurement. Conclusion  The longer the distance between the hyoid bone and the mandibular plane, the greater the preoperative AHI, and LP was an effective OSA treatment. Cephalometric variables are not able to modify or determine the success of LP in apneic patients in the population assessed.

Craniofacial morphology in Obstructive Sleep Apnea patients

Background

To evaluate the correlation between cephalometric skeletal parameters and Obstructive Sleep Apnea syndrome (OSAs) severity, in adult patients with OSAs.

Material and Methods

One hundred patients (94 males,6 females mean age 59,3) with diagnosis of OSAs were retrospectively enrolled. Each patient received Home Sleep Apnea Testing (HSAT) and latero-lateral radiograph. Eight cephalometric parameters (cranial deflection angle, saddle angle, articular angle, divergence angle, cranial base angle, skull base length, mandibular length, maxilla length) were analyzed and then related to Apnea/Hypopnea Index (AHI) and to the Oxygen Desaturation Index (ODI), recorded by HSAT. A Spearman's rho correlation test between cephalometric measurements and HSAT indices was performed. Statistical significance was set at p< 0.05.

Results

A negative statistically significant correlation was found between mandibular length (Condilion-Gnathion distance) and AHI (rho= -0,2022; p<0,05) and between maxilla length (Ans-Pns) and AHI (rho= -0,2984; p<0,01) and ODI (rho= -0,2443; p<0,05). A statistically significant correlation was also observed between the divergence angle (S-N^Go-Me) and AHI (rho=0,2263; p<0,05) and between cranial deflection angle (Fh^NBa) and AHI (rho=0,2212; p<0,05) and ODI (rho=0,1970; p<0,05).

Conclusions

The OSAs severity may be related to certain predisposing features in craniofacial morphology, such as maxillary and mandibular length, divergence and cranial deflection. Key words:OSAs, Home Sleep Apnea Testing, AHI, ODI, Cephalometry, Airway.

The Prevalence of Obstructive Sleep Apnea and Associated Symptoms among Patients with Sickle Cell Disease: A Systematic Review and Meta-analysis

Previous studies have shown that patients with sickle cell disease (SCD) are at high risk for obstructive sleep apnea (OSA). In the current study, we aimed to systematically review the literature to address the prevalence of OSA and associated symptoms among patients with SCD. Electronic databases, including Web of Science, Scopus, PubMed, Google Scholar, and Embase were systematically searched to identify the relevant original articles on patients with SCD. Newcastle Ottawa scale was used for quality assessment. Data were pooled by using random effects models. Subgroup analyses were performed by age groups. Thirty-nine studies containing details of 299,358 patients with SCD were included. The pooled results showed that more than half of these patients had OSA with different severities. The prevalence rates of OSA among children with apnea hypopnea index (AHI) cutoffs of above 1, 1.5, and 5 were 51% (95% confidence interval (CI) 36-67%), 29% (95% CI 19-40%), and 18% (95% CI 14-23%), respectively. The prevalence of OSA among adults with AHI cutoff of 5 was 43% (95% CI 21-64%). The pooled rates of snoring, nocturnal enuresis, nocturnal desaturation, and daytime sleepiness were 55% (95% CI 42-69%), 37% (95% CI 33-41%), 49% (95% CI 26-72%), and 21% (95% CI 12-30%), respectively. Given the high prevalence of OSA in patients with SCD, probable greater burden of SCD complications, and irreversible consequences of OSA, screening for OSA symptoms and signs seems useful in these patients. By screening and identifying this heterogeneous disorder earlier, available treatment modalities can be individualized for each patient.

Using Machine-Learning to Predict Sleep-Disordered Breathing Diagnosis From Medical Comorbidities and Craniofacial Features

Objectives This paper attempts to use machine-learning (ML) algorithms to predict the presence of sleep-disordered breathing (SDB) in a patient based on their body habitus, craniofacial anatomy, and social history. Materials and methods Data from a group of 69 adult patients who attended a dental clinic for oral surgeries and dental procedures in the last 10 years was used to train machine-learning models to predict whether a subject is likely to have SDB based on input information such as age, gender, smoking history, body mass index (BMI), oropharyngeal airway (Mallampati assessment), forward head posture (FHP), facial skeletal pattern, and sleep quality. Logistic Regression (LR), K-nearest Neighbours (kNN), Support Vector Machine (SVM) and Naïve Bayes (NB) were selected as these are the most frequently used supervised machine-learning models for classification of outcomes. The data was split into two sets for machine training (80% of total records) and the remaining was used for testing (validation). Results Initial analysis of collected data showed overweight BMI (at 25 or above), periorbital hyperchromia (dark circle eyes), nasal deviation, micrognathia, convex facial skeletal pattern (class 2) and Mallampati class 2 or above have positive correlations with SDB. Logistic Regression was found to be the best performer amongst the four models used with an accuracy of 86%, F1 score of 88% and area under the ROC curve (AUC) of 93%. LR also had 100% specificity and 77.8% sensitivity. Support Vector Machine was the second-best performer with an accuracy of 79%, F1 score of 82% and AUC of 93%. k-Nearest Neighbours and Naïve Bayes performed reasonably well with F1 scores of 71% and 67%, respectively. Conclusions This study demonstrated the feasibility of using simple machine-learning models as a credible predictor of sleep-disordered breathing in patients with structural risk factors for sleep apnoea such as craniofacial anomalies, neck posture and soft tissue airway obstruction. By utilising higher-level machine-learning algorithms, it is possible to incorporate a broader range of risk factors, including non-structural features like respiratory diseases, asthma, medication use, and more, into the prediction model.

Correlations between Morphology, the Functional Properties of Upper Airways, and the Severity of Sleep Apnea

Obstructive sleep apnea (OSA) is considered the silent killer pathology of the new millennium. This is due to increased risk factors such as obesity. Healthcare systems face an increasing burden from severe cases of OSA. We performed a study on a group of 152 Romanian patients with OSA recording data obtained through polysomnography and cephalometric variables, recorded in lateral plain X-rays. The results confirmed some of the data available from previous studies worldwide, but some of the variables presented a positive statistical correlation specific to our study group. For example, the apnea-hypopnea index (AHI) correlated with the uvula length but surprisingly did not correlate with body mass index (BMI) because obesity tends to become endemic in Romania. To our knowledge, this is one of the first studies focusing on cephalometric data in Romanian OSA patients. The results obtained through this study will be further analyzed in research on larger groups of Romanian OSA patients.

Correlation between Apnea Severity and Sagittal Cephalometric Features in a Population of Patients with Polysomnographically Diagnosed Obstructive Sleep Apnea

Background and Objective: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder featuring a repeated closure of the upper airway during sleep. Craniofacial anatomy is a potential risk and worsening factor for OSA. This study aims to assess the relationship between cephalometric features of craniofacial morphology and OSA severity in a population of patients with OSA. Material and Methods: A sample of forty-two patients (n = 42, M = 76%, mean age = 57.8 ± 10.8) with a polysomnographically (PSG) confirmed diagnosis of OSA were recruited and underwent cephalometric evaluation of 16 cephalometric variables. In addition, the apnea−hypopnea index (AHI), oxygen desaturation (SatMin), Epworth sleepiness scale (ESS), and body mass index (BMI) were assessed. Then t-tests were performed to compare the values of all cephalometric variables between two AHI severity-based groups (mild-to-moderate = AHI ≤ 30; severe = AHI > 30). Single- and multiple-variable regression analyses were performed to assess the associations between AHI scores and cephalometric features. Results: Mean AHI, SatMin, and BMI were 31.4 ev/h, 78.7%, and 28.1, respectively. The cephalometric variables were not significantly different between the two OSA-severity groups (p > 0.05). Multiple-variable regression analyses showed that gonial angle and nasopharynx space were negatively associated with AHI, explaining 24.6% of the total variance. Conclusion: This investigation reported that severity of AHI scores in patients with OSA showed a negative correlation with gonial angle and nasopharynx space. As a general remark, although maxillofacial anatomy can be a predisposing factor for OSA, disease severity depends mainly upon other variables.

Development, testing, and feasibility of a customized mobile application for obstructive sleep apnea (OSA) risk assessment: A hospital-based pilot study

Introduction

Obstructive Sleep Apnea (OSA), the most prevalent form of sleep-related breathing disorder has practical and financial limitations in diagnosis by polysomnography, hence OSA risk-assessment can identify OSA-related symptoms early.

Objectives

To develop a mobile application for OSA-risk assessment and tests its validity, feasibility, and application in a hospital-based pilot sample.

Study design and methods

The study comprised of two parts.

Part i

Development of a mobile application "OSA-Risk Assessment Tool" using automated questionnaires.

Part ii

A pilot study to screen OSA-risk in 200 patients (100 adults,100 children) from the orthodontic OPD of a Govt. Dental Hospital, using the mobile application. Internal validation by manual and mobile-based methods was done on 30 random patients. Non-parametric tests assessed the statistical differences between OSA-risk and nonOSA-risk variables.

Results

The prevalence of OSA-risk was 21.4% in adults and 8% in children. In adults, OSA-risk showed significantly greater neck circumference (p = 0.0001), waist circumference(p = 0.001), body mass index(p = 0.008), daytime sleepiness, headache, and mouth breathing(p = 0.0001). In children, OSA-risk is associated with a dry mouth on awakening, daytime sleepiness, and mouth breathing, and nocturnal enuresis. The low OSA-risk patients were suggested standardized preventive management counseling and orthodontic interventions while medium to high-risk underwent sleep-specialist referrals.

Conclusions

This study supports the feasibility and usability of the mobile application "OSA-risk assessment tool" in a hospital setup. This cost-effective tool can be advocated for self-evaluation, early detection, and awareness in pandemic times. The future upgraded versions may include preventive modules and real-time coordination with the nearest sleep clinics and specialists.

Cone beam computed tomography analysis results in patients with obstructive sleep apnoea syndrome

INTRODUCTION

The present study aimed to investigate the contribution of cone-beam computed tomography (CBCT) to the diagnosis of obstructive sleep apnoea syndrome (OSAS).

METHODS

The present study investigate the relationships among body mass index (BMI), upper airway, septum deviation, nasal cavity width, airway, and the hard and soft palate width using CBCT images of 64 patients obtained in Uşak University Faculty of Dentistry. The study included 31 (8 female and 23 male; mean age: 52.52 ± 10.01 years) and 33 patients (12 female and 21 male; mean age: 47.39 ± 10.27 years) with and without OSAS, respectively. Between-group comparisons of non-normally and normally distributed variables were performed using the Mann-Whitney U test and Student's t-test, respectively. Spearman's correlation analysis was used to determine the relationship between quantitative data. Statistical significance was evaluated at P < .01 and P < .05.

RESULTS

There were significant differences between groups in the BMI, nasal septum position, hard and soft palate width, maxillary skeletal width, and palatal alveolar angle (P < .01). In addition it was also found that BMI was higher, the nasopharyngeal airway was longer, and the soft palate was longer and wider in males. (P = .001; P < .01).

CONCLUSION

This study concluded that patients with OSAS had marked narrowing of the upper airway, nasal cavity and maxillary width, shortening and enlargement of the soft palate, and marked increase in BMI. However, to gather sufficiently reliable data for routine use in orthodontic analyses, there is a need for greater number of samples to improve the database.