Subgrouping persons with snoring and/or apnea by using anthropometric and cephalometric measures

Helmet Treatment of Infants With Deformational Brachycephaly

Deformation of the cranium in infancy represents a spectrum of deformity, ranging from severe asymmetric yet proportional distortion of the skull in plagiocephaly, to nearly symmetric yet disproportional distortion in brachycephaly. As such, the condition is best described as deformational plagiocephaly-brachycephaly with isolated plagiocephaly and/or isolated brachycephaly being at either ends of the spectrum. Due to its symmetric appearance, deformational brachycephaly is often incorrectly dismissed as being less concerning, and it has sometimes erroneously been reported that brachycephaly cannot be treated successfully with a cranial orthosis. We prospectively report on 4205 infants with isolated deformational brachycephaly treated with a cranial orthosis from 2013 to 2017. These results demonstrate that the orthosis is successful in the treatment of deformational brachycephaly with an 81.4% improvement toward normal (95.0 to 89.4) in cephalic index. We furthermore demonstrate that entrance age influences treatment results, with younger infants demonstrating both improved outcomes and shorter treatment times.

Sleep clinical record: what differences in school and preschool children?

The sleep clinical record (SCR) may be a valid method for detecting children with obstructive sleep apnoea (OSA). This study aimed to evaluate whether there were differences in SCR depending on age and to identify the possible risk factors for OSA development.

We enrolled children with sleep disordered breathing between 2013 and 2015, and divided them according to age into preschool- and school-age groups. All patients underwent SCR and polysomnography.

OSA was detected in 81.1% and 83.6% of preschool- and school-age groups, respectively. Obesity, malocclusions, nasal septal deviation and inferior turbinate hypertrophy were significantly more prevalent in school-age children (p<0.05); however, only tonsillar hypertrophy had significant hazard ratio (2.3) for OSA development. Saddle nose, nasal hypotonia, oral breathing and tonsillar hypertrophy were significantly more prevalent for development of OSA in preschoolers (p<0.03). The SCR score was significantly higher among preschool children than in school-age children (8.4±2.22 versus 7.9±2.6; p=0.044). Further, SCR score >6.5 had a sensitivity of 74% in predicting OSA in preschool children with positive predictive value of 86% (p=0.0001).

Our study confirms the validity of the SCR as a screening tool for patient candidates for a PSG study for suspected OSA, in both school and preschool children.

The differences in sleep clinical record between school and preschool children suspected to have OSAhttp://ow.ly/X778Q

Surface cephalometric and anthropometric variables in OSA patients: statistical models for the OSA phenotype

STUDY OBJECTIVE

We used statistical modelling to probe the contributions of anthropometric and surface cephalometric variables to the OSA phenotype.

DESIGN

The design is prospective cohort study.

SETTING

The setting is community-based and sleep disorder laboratory.

PATIENTS OR PARTICIPANTS

Study #1-Model development study: 147 healthy asymptomatic volunteers (62.6 % Caucasian; age, 18-76 years; 81 females; median multivariable apnea prediction index=0.15) and 140 diagnosed OSA patients (84.3 % Caucasian; age, 18-83 years; 41 females; polysomnography [PSG] determined apnea-hypopnea index >10 events/h). Study #2-Model test study: 345 clinic patients (age, 18-86 years; 129 females) undergoing PSG for diagnosis of OSA.

INTERVENTION

We measured 10 anthropometric and 34 surface cephalometric dimensions (calipers) and calculated mandibular enclosure volumes for study #1 and recorded age and neck circumference for study #2. Statistical modelling included principal component (PC), logistic regression, and receiver-operator curve analyses.

MEASUREMENTS AND RESULTS

Model development study: A regression model incorporating three identified PC predicted OSA with 88 % sensitivity and specificity. However, a simplified model based on age and NC alone was equally effective (87 % sensitivity and specificity). Model test study: The simplified model predicted OSA with high sensitivity (93 %) but poor specificity (21 %).

CONCLUSION

We conclude that in our clinic-based cohort, craniofacial bony and soft tissue structures (excluding neck anatomy) do not play a substantial role in distinguishing patients with OSA from those without. This may be because craniofacial anatomy does not contribute greatly to the pathogenesis of OSA in this group or because referral bias has created a relatively homogeneous phenotypic population.

Lateral cephalometric analysis and the risks of moderate to severe obstructive sleep-disordered breathing in Thai patients

PURPOSES

This cross-sectional study was aimed to compare lateral cephalometric parameters among patients with different severities of obstructive sleep-disordered breathing and to determine if there are radiographic variables that increase risk of moderate to severe obstructive sleep apnea (OSA).

METHODS

Ten linear and 5 angular parameters of lateral cephalometry in 188 adult subjects which included 47 controls and 141 patients with OSA classified by apnea-hypopnea index (AHI) from level-I polysomnography, were analyzed. All radiographs were done under standardized processes and measured twice on separate occasions.

RESULTS

There were statistically significant differences between controls and patients with AHI ≥ 15 in parameters such as a distance from mandibular plane to hyoid (MP-H), posterior airway space (PAS), skull base angle (NSBA), a distance from posterior nasal spine to posterior pharyngeal wall (PNS-PP), and soft palate length (PNS-P), (p < 0.01). However, no significant difference was found between controls and mild OSA. Logistic regression analysis showed that only MP-H with cutoff point of ≥ 18 millimeters, NSBA ≤ 130°, and PAS ≤ 10 millimeters were independent cephalometric variables that increased risk of having AHI ≥ 15 compared to controls with adjusted odds ratio of 17.1, 8.3 and 4.2, respectively. Gender did not significantly associate with OSA severity in this analysis.

CONCLUSIONS

Patients who had longer MP-H, narrower PAS and narrower NSBA than specific cutoff points significantly increased risks of moderate to severe OSA. Treatments that effectively improve these parameters, particularly at tongue base level (MP-H and PAS), may decrease the severity of disease.