Craniofacial and upper airway profile assessment in North Indian patients with obstructive sleep apnea

The association of upper airway anatomy with cognitive test performance: the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Numerous upper airway anatomy characteristics are risk factors for sleep apnea, which affects 26% of older Americans, and more severe sleep apnea is associated with cognitive impairment. This study explores the pathophysiology and links between upper airway anatomy, sleep, and cognition.

METHODS

Participants in the Multi-Ethnic Study of Atherosclerosis underwent an upper airway MRI, polysomnography to assess sleep measures including the apnea-hypopnea index (AHI) and completed the Cognitive Abilities Screening Instrument (CASI). Two model selection techniques selected from among 67 upper airway measures those that are most strongly associated with CASI score. The associations of selected upper airway measures with AHI, AHI with CASI score, and selected upper airway anatomy measures with CASI score, both alone and after adjustment for AHI, were assessed using linear regression.

RESULTS

Soft palate volume, maxillary divergence, and upper facial height were significantly positively associated with higher CASI score, indicating better cognition. The coefficients were small, with a 1 standard deviation (SD) increase in these variables being associated with a 0.83, 0.75, and 0.70 point higher CASI score, respectively. Additional adjustment for AHI very slightly attenuated these associations. Larger soft palate volume was significantly associated with higher AHI (15% higher AHI (95% CI 2%,28%) per SD). Higher AHI was marginally associated with higher CASI score (0.43 (95% CI 0.01,0.85) per AHI doubling).

CONCLUSIONS

Three upper airway measures were weakly but significantly associated with higher global cognitive test performance. Sleep apnea did not appear to be the mechanism through which these upper airway and cognition associations were acting. Further research on the selected upper airway measures is recommended.

Ultrasonography of the neck in patients with obstructive sleep apnea

INTRODUCTION

In resource-limited settings, obstructive sleep apnea (OSA) often goes undiagnosed as polysomnography (PSG) is expensive, time-consuming, and not readily available. Imaging studies of upper airway have been tried as alternatives to PSG to screen for OSA. However, racial differences in upper airway anatomy preclude generalizability of such studies. We sought to test the hypothesis that ultrasonography (USG), an inexpensive, readily available tool to study soft tissue structures of the upper airway, would have predictive value for OSA in South Asian people.

METHODS

Adult patients with sleep-related complaints suspicious for OSA were taken for overnight PSG. After the PSG, consecutive patients with and without OSA were studied with submental ultrasonography to measure tongue base thickness (TBT) and lateral pharyngeal wall thickness (LPWT).

RESULTS

Among 50 patients with OSA and 25 controls, mean age was 43.9 ± 11.4 years, and 39 were men. Patients with OSA had higher TBT (6.77 ± 0.63 cm vs 6.34 ± 0.54 cm, P value = 0.004) and higher LPWT (2.47 ± 0.60 cm vs 2.12 ± 0.26 cm, P value = 0.006) compared to patients without OSA. On multivariate analysis, TBT, LPWT, and neck circumference were identified as independent factors associated with OSA. These variables could identify patients with severe OSA with a sensitivity of 72% and a specificity of 76%.

CONCLUSION

Patients with OSA have higher tongue base thickness and lateral pharyngeal wall thickness proportionate to the severity of the disease, independent of BMI and neck circumference. These findings suggest that sub-mental ultrasonography may be useful to identify patients with severe OSA in resource-limited settings.

The Interaction of Craniofacial Morphology and Body Mass Index in Obstructive Sleep Apnea

Aim: This study sets out to explore the relationship between craniofacial morphology and obstructive sleep apnea (OSA) severity, assessing the relative contribution of obesity, calculated using BMI. Methods: A sample of 30 adult patients (20 males; 10 females), mean age = 54(±76) years, with a polysomnography-confirmed diagnosis of OSA, i.e., with an apnea-hypopnea index (AHI) of over 5 events/h, was recruited and underwent cephalometric evaluation. Sleep parameters, namely AHI, AHI supine, oxygen desaturation index (ODI), and mean oxygen saturation [Mean SaO2%], were assessed. Correlation analysis between 13 cephalometric features and AHI was performed using a Pearson test. The sample was split into three groups based on AHI score (mild = 10 < AHI < 15; moderate = 15 < AHI < 30; severe = AHI > 30), and ANOVA was performed to compare the means of cephalometric features. In addition, the sample was split into two groups according to BMI (normal weight = BMI < 25; overweight = BMI > 25). Correlation analysis between cephalometric features and AHI was performed for each group using a Pearson test. Results: The average polysomnographic values were AHI = 29.08(±16); AHI supine = 43.45(±21); ODI = 23.98(±21); mean SaO2(%) = 93.12(±2). Posterior facial height (PFH) was significantly lower in the severe OSA group than in patients with moderate OSA (p = 0.05). In the normal-weight group, negative correlations of the PFH and SNA angle with AHI (r = −0.36; r = −0.25, respectively), and positive correlations of the FMA angle and MP-H distance with AHI (r = 0.29; r = 0.20, respectively), were found. In the overweight group, negative correlations of AO-BO distance, SPAS (upper posterior airway space) and PAS (posterior airway space) with AHI (r = −0.30; r = −0.28; r = −0.24, respectively), and positive correlations of AFH (anterior facial height) and the FMA angle with AHI (r = 0.32; r = 0.25, respectively), emerged. Conclusions: PFH seems to be related to the aggravation of OSA. In normal-weight subjects, hard tissue-related factors have a greater impact on OSA severity, whereas in overweight subjects, the impact of fat tissue is greater.

Evaluation and Management of Snoring

Snoring can be harmless (primary) or a symptom of sleep-disordered breathing (secondary) and should alert the physician to evaluate the patient for risks thereof. Phenotypes of snoring and sleep-disordered breathing (SDB) are anatomic and nonanatomic and identifying these phenotypes and their interrelationships are critical to effective therapy. Mouth breathing alerts the physician to nasal airway obstruction, signals orofacial growth changes in children, and heralds the progression of SDB. Systematic evaluation to establish phenotypes includes assessing sleep habits, comorbidities, upper airway examination, polysomnography, and drug-induced sleep endoscopy. Strategies for treatment should be personalized and precise to the phenotype(s) to achieve the most benefit.

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.