1
|
Huang L, Xu Y, Gong X, Gao X. Anatomical phenotype of obstructive sleep apnea patients based on cluster analysis. Orthod Craniofac Res 2023; 26:608-617. [PMID: 36919983 DOI: 10.1111/ocr.12653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/19/2023] [Accepted: 03/05/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To generate a novel subtype of obstructive sleep apnea (OSA) based on anatomical features and verify the differences in the response of different subtypes to orthodontic treatment, thus providing a theoretical reference for clinical decision-making. MATERIALS AND METHODS A K-means cluster analysis was performed for this retrospective serial study, which includes 722 OSA patients, aged 44.0 (36.0, 54.0) years, 80.2% male, with apnea-hypopnea index (AHI) of 23.2 (13.4, 39.6) events·h-1 , and body mass index (BMI) of 25.47 ± 3.00 kg·m-2 . All samples were divided into three subtypes based on AHI, BMI, and five variables of craniofacial measurements. Sixty-seven cases with mandibular advancement devices (MAD) therapeutic results were further applied to validate the efficacy and side effects of this treatment in different subtypes. RESULTS Two hundred and thirty patients (31.9%) were characterized as cluster 1: AHI of 17.65 (11.80, 30.42) events·h-1 , BMI of 23.65 ± 2.62 kg·m-2 , with skeletal Class II high-angle shape. Cluster 2 included 278 patients (38.5%): AHI of 17.00 (11.00, 26.48) events·h-1 , BMI of 25.36 ± 2.53 kg·m-2 , soft palate length (SPL) of 39.25 mm (36.12, 42.20), with basically normal skeleton and normal airway size. Cluster 3, consisting of 214 patients (29.6%), exhibited a combination of anatomical deformity and obesity, with the highest AHI and BMI of 45.35 (30.42, 62.53) events·h-1 and 27.57 ± 2.59 kg·m-2 respectively, but less deformity degree than cluster 1. Cluster 2 had the highest response rate and relatively mild side effects with MAD. CONCLUSIONS Orthodontic treatment based on anatomical morphology could exert a better effect on mild-moderate OSA patients with mild skeletal deformity.
Collapse
Affiliation(s)
- Liping Huang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ying Xu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xu Gong
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| |
Collapse
|
2
|
Liao FC, Zhang T, Huang XP, Sangwatanakul J, Li HY, Zhou N. Correlation analysis of upper airway morphology in patients with obstructive sleep apnea and anatomically small retruded mandibles. Cranio 2023; 41:416-422. [PMID: 33355036 DOI: 10.1080/08869634.2020.1864165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the relationship between upper airway morphology and the severity of obstructive sleep apnea (OSA) in patients with anatomically small retruded mandibles. METHODS Fifty-two patients with small retruded mandibles underwent polysomnography and airway computed tomography. The airway morphology parameters and sleep assessment were compared between the patients with or without OSA. RESULTS Twenty-eight patients diagnosed with OSA, according to polysomnography, had a higher distance between the hyoid bone and mandibular plane (HMP), lateral dimension (LAT)/anteroposterior dimension (AP), but lower minimum cross-sectional area (mCSA), AP, surface area, volume, avgCSA, and airway uniformity (U). The apnea-hypopnea index had negative correlations with mCSA, AP, surface area, volume, avgCSA, and U, and had a positive correlation with HMP and LAT/AP. CONCLUSION OSA is common among patients with small retruded mandibles and is associated with a more compressed upper airway shape and longer HMP.
Collapse
Affiliation(s)
- Feng-Chun Liao
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, People's Republic of China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, People's Republic of China
| | - Tao Zhang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, People's Republic of China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, People's Republic of China
| | - Xuan-Ping Huang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, People's Republic of China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, People's Republic of China
| | - Jirayus Sangwatanakul
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, People's Republic of China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, People's Republic of China
| | - Hong-Yi Li
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, People's Republic of China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, People's Republic of China
| | - Nuo Zhou
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, People's Republic of China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Nanning, People's Republic of China
- Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, People's Republic of China
| |
Collapse
|
3
|
Xu Q, Wang X, Li N, Wang Y, Xu X, Guo J. Craniofacial and upper airway morphological characteristics associated with the presence and severity of obstructive sleep apnea in Chinese children. Front Pediatr 2023; 11:1124610. [PMID: 37063671 PMCID: PMC10102523 DOI: 10.3389/fped.2023.1124610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
Objectives To identify craniofacial and upper airway morphological characteristics associated with the presence and severity of obstructive sleep apnea (OSA) in children. Methods This study consisted of 82 OSA children and 77 controls (age 5-10 years). All subjects underwent cephalograms and were divided into a 5-7 age group and an 8-10 age group. Cephalometric variables were compared between OSA children and controls, and hierarchical regression analysis was performed to examine the relationship between cephalometric variables and OSA severity [expressed by the obstructive apnea-hypopnea index (OAHI)] in different age groups. Results Increased A/N ratio, narrowed posterior airway space, decreased SNA and SNB angles, and shortened ramus height were observed among OSA children in different age groups. In the 5-7 age group, the A/N ratio and a lower gonial angle explained 40.0% and 14.7% of the variance in the OAHI, respectively. In the 8-10 age group, the BMI z-score and A/N ratio explained 25.2% and 6.6% of the variance in the OAHI, followed by a lower gonial angle and the hyoid-retrognathion distance (19.1% in total). Conclusions Adenoid hypertrophy was a major factor associated with OSA in preschool children, whereas obesity replaced adenoid hypertrophy as the main contributor to OSA in late childhood. Several craniofacial skeletal variables such as the SNB angle, ramus height, lower gonial angle, and hyoid position are also associated with the presence and/or severity of OSA, which could be used to help recognize children at a higher risk for OSA.
Collapse
Affiliation(s)
- Qiuping Xu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
- Department of Stomatology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoya Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Na Li
- Department of Orthodontics, Ningbo Stomatology Hospital & Savaid Stomatology School, Hangzhou Medical College, Ningbo, China
| | - Ying Wang
- Department of Orthodontics, Ningbo Stomatology Hospital & Savaid Stomatology School, Hangzhou Medical College, Ningbo, China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Jing Guo
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
- Department of Orthodontics, Ningbo Stomatology Hospital & Savaid Stomatology School, Hangzhou Medical College, Ningbo, China
- Correspondence: Jing Guo
| |
Collapse
|
4
|
Mahale AR, Rao P, Ullal S, Fernandes M, Prabhu S. Computed Tomography and Cephalometric Evaluation of Obstructive Sleep Apnea Syndrome. Indian J Otolaryngol Head Neck Surg 2022; 74:5134-5143. [PMID: 36742538 PMCID: PMC9895697 DOI: 10.1007/s12070-021-02980-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
To examine the changes of upper airway cross sectional area in each phase of respiration in different degrees of severity of OSAS with computed tomography and cephalometry to decide on further treatment. A Prospective study was done in the Department of Radiology and Imaging, Kasturba Medical College, Mangalore, spanning over a period from March 2017 to December 2019. 50 patients were included in the study including control group. Patients who had at least 2-3 major symptoms of sleep apnea such as snoring, daytime somnolence, and apnea were included in this study. All patients were examined and then subjected to polysomnography(PSG) and upper airway CT. Patients with apnea-hypopnea index (AHI) of < 5 on Polysomnography were included in the control group and those with AHI of > 5 were categorized in to the study group Cross-sectional area of the airway at the level of the nasopharynx, oropharynx and the hypopharynx were obtained. Standard cephalometric measurements were made on a lateral radiograph of skull/ CT scanogram. Of the 36 patients in the study group, 31 patients were males and 5 were females. In the control group of 12 patients, 8 were males and 4 females. The cross sectional area at the lower border of the nasopharynx which is also the level of the nasopharyngeal sphincter was the most affected level in OSAS (p value of < 0.0001). Mean uvular diameter in the control group was 9.6 mm and in the OSAS group it was 11.2 mm. The mean length of the soft palate was 36.4 mm in the controls, 39.5 mm in the mild/moderate OSAS and 41.2 mm in the severe OSAS group. Obstructive sleep apnea is a complex disorder characterized by apneic episodes during sleep. In this study the most common site of obstruction is nasopharyngeal sphincter and the oropharynx. Although PSG is the diagnostic test of choice, imaging plays an important role in planning surgical and conventional treatment.
Collapse
Affiliation(s)
- Ajit R. Mahale
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| | - Pallavi Rao
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| | - Sonali Ullal
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| | - Merwyn Fernandes
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| | - Sonali Prabhu
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| |
Collapse
|
5
|
Cheng L, Jiang Y, Man S, Wang Y, Yang Y, Zhou M. X-Ray Cephalometric Analysis of the Effects of Angle Class II and III Malocclusion on the Upper Airway Width and Hyoid Position between Parents and Children of Uygur Nationality. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2531419. [PMID: 35903431 PMCID: PMC9325337 DOI: 10.1155/2022/2531419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
Objective The objective of this paper is to analyze the effect of angle class II and III malocclusion on the sagittal diameter of the upper airway between parents and children of Uygur nationality and to compare the degree of influence. Methods 29 Uygur adolescents with malocclusion and their fathers (mothers) were selected as our subjects via X-ray cephalometric radiograph to analyze the difference between the upper airway sagittal dimension and normal occlusion and compare the influence of malocclusion on the upper airway between parents and children. Results Compared with normal group, the vertical distance from the hyoid point to orbital-ear plane (H-FH) and vertical distance from hyoid point to the mandibular plane (H-MP) in angle class II malocclusion elevated signally, while the vertical distance from hyoid point to anterior cervical plane (H-VL), PNS-UPW, H-FH, and H-MP decreased significantly; compared with normal group: the distance between the posterior nasal spine and the upper pharynx wall (PNS-UPW), H-FH, and H-MP in angle class III malocclusion visually reduced, while PAS, and horizontal distance from the hyoid point and center point of sella turcica to orbital-ear foot (H-S), increased markedly. The impact of class II malocclusion on parents' U-MPM was greater than their children. Conclusion The oropharyngeal space of upper airway becomes smaller and hyoid shifts downwards due to class II malocclusion. Class III malocclusion results in decreased nasopharyngeal gap with hyoid to shift upward. The influence of class II malocclusion on the upper pharyngeal tract of parents was greater than their children.
Collapse
Affiliation(s)
- Lijun Cheng
- Department of Stomatology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province 050000, China
| | - Yuxin Jiang
- Department of Stomatology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province 050000, China
| | - Shasha Man
- Department of Stomatology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province 050000, China
| | - Yanan Wang
- Department of Stomatology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province 050000, China
| | - Yan Yang
- Department of Stomatology, People's Hospital of Bayinguleng Mongolian Autonomous Prefecture, Kuerla, Xinjiang 841000, China
| | - Mi Zhou
- Department of Stomatology, People's Hospital of Bayinguleng Mongolian Autonomous Prefecture, Kuerla, Xinjiang 841000, China
| |
Collapse
|
6
|
Wang X, Chen H, Jia L, Xu X, Guo J. The relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea in adults. Eur J Orthod 2021; 44:78-85. [PMID: 34268561 DOI: 10.1093/ejo/cjab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea (OSA) using cone beam computed tomography (CBCT). METHODS This was a prospective observational study, consisted of 95 adult OSA whose polysomnography and CBCT were available. Three-dimensional craniofacial and upper airway anatomical analysis were performed using 12 CBCT variables, including sagittal and vertical jaw relationships, maxillary width, the volume, length and minimum axial area of upper airway. The severity of OSA was evaluated through the apnea-hypopnea index (AHI). A hierarchical regression was performed to analyze the relationship between OSA severity and craniofacial and upper airway anatomical variables after controlling patients' demographic characteristics (gender, age, and BMI). RESULTS After controlling patients' gender, age, and BMI, individual CBCT variables including MAA, V-RPA, L-RPA and Go-Me were related to AHI. The final hierarchical regression model with demographic variables in Step 1 and CBCT variables (MAA, L-RPA and Go-Me) in Step 2 indicated that CBCT variables added additional explanatory power for AHI (ΔF(3,88) = 5.176, P = 0.002). Among these variables, L-RPA and Go-Me were statistically significant (P < 0.05). LIMITATION The OSA severity was expressed by AHI alone. CONCLUSIONS Three-dimensional craniofacial and upper airway morphology played an essential role in OSA severity. The most relevant anatomical characteristic with OSA severity were the length of retropalatal airway and mandibular body, which could be used to recognize severe OSA patients and as estimators for selecting the most appropriate treatment modality for OSA patients.
Collapse
Affiliation(s)
- Xiaoya Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China.,Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Hui Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Lu Jia
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Jing Guo
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| |
Collapse
|
7
|
Upper Airway Resistance Syndrome: a Combined ENT and Dental Approach. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
8
|
Three-Dimensional Measurement of Oropharynx and Laryngopharynx in Children With Hemifacial Microsomia. J Craniofac Surg 2021; 32:1331-1333. [PMID: 33710054 DOI: 10.1097/scs.0000000000007361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study focused on evaluating different parts of the airway in patients with hemifacial microsomia classified by the Pruzansky-Kaban classification system. METHODS Volumetric and morphologic airway parameters of 66 children with hemifacial microsomia were measured on 3D models. Using the Pruzansky-Kaban system, the patient cohort was composed of seven I-type, 14 IIa type, 27 IIb type, and 18 III type patients. RESULTS The total airway volume was not statistically different among groups. In the 3D oropharynx models, volume and surface area of the oropharynx decreased from the type I group to the type IIb group. However, no statistically significant difference was found for length (P = 0.965) or minimum cross-sectional area (mini-CSA, P = 0.550) of the oropharynx in the type III group compared to the other groups. In the 3D laryngopharynx models, the mean-CSA (P = 0.413) and mini-CSA (P = 0.378) were not statistically different among groups. In contrast, volume (P = 0.014), length (P = 0.005), and surface area (P = 0.032) of the laryngopharynx were reduced from type I to type III. Kruskal-Wallis analysis indicated statistically significant differences of volume (P = 0.004), length (P = 0.017), and surface area (P = 0.010) of the laryngopharynx among groups I, IIa, and IIb. The mean-CSA (P = 0.247) and mini-CSA (P = 0.206) of the laryngopharynx were not correlated with the different clinical types. CONCLUSION The mean-CSA varied significantly from type I to IIb at the level of oropharynx. In addition, the volume of the laryngopharynx decreased from type I to type III. However, type III was unique in this study with nonseverely airway measurement results.
Collapse
|
9
|
Chang CH, Huang CC, Wang YH, Chou FJ, Chen JW. Ultrasound Shear-Wave Elastography of the Tongue in Adults with Obstructive Sleep Apnea. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1658-1669. [PMID: 32402674 DOI: 10.1016/j.ultrasmedbio.2020.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 05/17/2023]
Abstract
Obstructive sleep apnea (OSA) is a chronic breathing disorder characterized by intermittent sleep state-dependent upper airway (UA) collapse. The tongue comprises the primary UA dilator muscle and plays an essential role in the pathogenesis of OSA. We examined whether tongue stiffness measurement using ultrasound (US) shear wave elastography (SWE) is useful for predicting the existence of OSA. Forty-six participants (20 healthy controls and 26 patients with OSA) underwent transcutaneous submental SWE using a US system. Quantification with a shear modulus of 0-200 kPa was recorded during normal breathing and Müller's maneuver (MM). Polysomnography was used as the reference standard. Mid-sagittal tongue stiffness was significantly higher in awake patients with OSA than in controls during normal breathing and the MM (p < 0.0001). The posterior third of the tongue in patients with OSA had the highest value of shear modulus during the MM (p < 0.001). With cut-offs of 27.6 and 35.2 kPa for the whole tongue and posterior third during the MM, respectively, the sensitivity obtained was 69.2% and 76.9%, and the specificity was 85% and 95%, respectively, for detecting OSA. The corresponding areas under the receiver operating characteristic curve were 0.82 and 0.88, respectively. US SWE may have the potential for non-invasive tongue stiffness measurement in OSA.
Collapse
Affiliation(s)
- Chun-Hsiang Chang
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Ya-Hui Wang
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Medical Research Center, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Fang-Ju Chou
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Medical Research Center, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
| |
Collapse
|
10
|
Yu RB, Huang CC, Chang CH, Wang YH, Chen JW. Prevalence and patterns of tongue deformation in obstructive sleep apnea: A whole-night simultaneous ultrasonographic and polysomnographic study. J Sleep Res 2020; 30:e13131. [PMID: 32578278 DOI: 10.1111/jsr.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 11/29/2022]
Abstract
Tongue deformation during whole-night natural sleep in adult patients with obstructive sleep apnea has not been well evaluated. Through simultaneous ultrasonography and polysomnography during whole-night sleep, we examined the prevalence and patterns of tongue depth changes and their relationship with the severity of obstructive sleep apnea. Sixty consecutive eligible adults presenting with symptoms suggesting obstructive sleep apnea were enrolled. We observed that 88.4% (38/43) of patients with obstructive sleep apnea exhibited a significant increase in the maximum ultrasonographic tongue depth when hypopnea or apnea occurred during sleep. A mixed-model analysis of variance demonstrated that compared with patients with primary snoring or mild obstructive sleep apnea, those with moderate to severe obstructive sleep apnea have significantly greater maximum ultrasonographic tongue depth during respiratory events (p = .0047). We identified three different ultrasonographic patterns of tongue deformation, namely en bloc, tongue body and tongue base. Approximately 82% (27/33) of patients with moderate to severe obstructive sleep apnea demonstrated an en bloc tongue deformation. By contrast, 70% (19/27) of primary snorers or patients with mild obstructive sleep apnea showed a tongue body obstruction. Recognizing the prevalence and patterns of tongue deformation during sleep may provide insights into pathogenesis and treatment decisions in patients with obstructive sleep apnea. Future studies are warranted to verify the treatment results of various tongue procedures by using this approach.
Collapse
Affiliation(s)
- Rui-Bin Yu
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Chun-Hsiang Chang
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ya-Hui Wang
- Medical Research Center, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| |
Collapse
|
11
|
Stipa C, Cameli M, Sorrenti G, Ippolito DR, Pelligra I, Alessandri-Bonetti G. Relationship between cephalometric parameters and the apnoea-hypopnoea index in OSA patients: a retrospective cohort study. Eur J Orthod 2020; 42:101-106. [PMID: 31143924 DOI: 10.1093/ejo/cjz038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the relationship between cephalometric parameters and apnoea-hypopnoea index (AHI) controlling for the effect of gender, age, and body mass index (BMI) on a large sample of patients with obstructive sleep apnoea (OSA). METHODS This retrospective cohort study was conducted on the lateral cephalograms of 253 Caucasian adult OSA patients. Cephalometric analyses were performed using 14 parameters for skeletal and soft tissue morphology, including antero-posterior and vertical jaw relationships, hyoid bone position, soft palate length and thickness, airway space, and tongue length and height. A hierarchical regression was run to examine the amount of variability in AHI that cephalometric variables explained after controlling for patients' general characteristics (gender, age, and BMI). RESULTS After controlling for gender, age, and BMI, the increase in AHI variance accounted for by cephalometric parameters was equal to 0.103. Among the cephalometric variables, only MP-H and PNS-P were statistically significant (P < 0.05). LIMITATIONS Given the retrospective nature of the study, it is difficult to assess whether other confounding variables not considered in the present study could have influenced the relationship between cephalometric parameters and AHI. CONCLUSIONS This study revealed the existence of a relationship between OSA severity and some cephalometric parameters. Indeed soft palate length and vertical position of the hyoid bone were significant predictors of AHI in adult Caucasian OSA patients.
Collapse
Affiliation(s)
- Chiara Stipa
- Department of Orthodontics, School of Dentistry, University of Bologna, Bologna
| | - Matteo Cameli
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II', Naples
| | - Giovanni Sorrenti
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Daniela R Ippolito
- Department of Orthodontics, School of Dentistry, University of Bologna, Bologna
| | - Irene Pelligra
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | | |
Collapse
|
12
|
Chien CY, Chen JW, Chang CH, Huang CC. Tracking Dynamic Tongue Motion in Ultrasound Images for Obstructive Sleep Apnea. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2791-2805. [PMID: 28942270 DOI: 10.1016/j.ultrasmedbio.2017.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/19/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
Obstructive sleep apnea (OSA), a breathing disorder characterized by repetitive collapse of the pharyngeal airway during sleep, can cause intermittent hypoxemia and frequent arousal. The evaluation of dynamic tongue motion not only provides the biomechanics and pathophysiology for OSA diagnosis, but also helps doctors to determine treatment strategies for these patients with OSA. The purpose of this study was to develop and verify a dedicated tracking algorithm, called the modified optical flow (OF)-based method, for monitoring the dynamic motion of the tongue base in ultrasound image sequences derived from controls and patients with OSA. The performance of the proposed method was verified by phantom and synthetic data. A common tracking method, the normalized cross-correlation method, was included for comparison. The efficacy of the algorithms was evaluated by calculating the estimated displacement error. All results indicated that the modified OF-based method exhibited higher accuracy in verification experiments. In the human subject experiment, all participants performed the Müller maneuver (MM) to simulate the contour changes of the tongue base with a negative pharyngeal airway pressure in sleep apnea. Ultrasound image sequences of the tongue were obtained during 10 s of a transition from normal breathing to the MM, and these were measured using the modified OF-based method. The results indicated that the displacement of the tongue base during the MM was larger in the controls than in the patients with OSA (p < 0.05); the calculated areas of the tongue in the controls and patients with OSA were 24.9 ± 3.0 and 27.6 ± 3.3 cm2, respectively, during normal breathing (p < 0.05), and 24.7 ± 3.6 and 27.3 ± 3.8 cm2, respectively, at the end of the MM. The percentage changes in the tongue area were 2.2% and 1.3% in the controls and patients with OSA, respectively. We found that quantitative assessment of tongue motion by ultrasound imaging is suitable for evaluating pharyngeal airway behavior in OSA patients with minimal invasiveness and easy accessibility.
Collapse
Affiliation(s)
- Chih-Yen Chien
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Jeng-Wen Chen
- Department of Otolaryngology Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hsiang Chang
- Department of Otolaryngology Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
13
|
Páez-Moya S, Parejo-Gallardo KJ. Cuadro clínico del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El pilar para el diagnóstico del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es el cuadro clínico obtenido mediante una historia clínica detallada. Los síntomas son referidos por el paciente o su compañero de cama y se pueden dar durante el sueño o la vigilia; estos últimos se presentan como consecuencia del trastorno del sueño. Los síntomas son consecuencia de la obstrucción de la vía aérea superior, de la hipoxia intermitente o de la fragmentación repetida del sueño.Para el diagnóstico de SAHOS, se deben tener en cuenta los factores agravantes, las comorbilidades, los antecedentes familiares, el examen físico, la obtención de medidas antropométricas, los signos vitales y los hallazgos anatómicos estructurales asociados con este síndrome o con alteraciones congénitas que lo predispongan. Tener conocimiento de estos aspectos clínicos es fundamental para alcanzar una buena aproximación a su diagnóstico.
Collapse
|
14
|
Patini R, Arrica M, Di Stasio E, Gallenzi P, Cordaro M. The use of magnetic resonance imaging in the evaluation of upper airway structures in paediatric obstructive sleep apnoea syndrome: a systematic review and meta-analysis. Dentomaxillofac Radiol 2016; 45:20160136. [PMID: 27440304 PMCID: PMC5606260 DOI: 10.1259/dmfr.20160136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/19/2016] [Accepted: 07/18/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES A systematic review was conducted to assess the effectiveness of MRI in evaluating upper airway structures in children affected by obstructive sleep apnoea syndrome (OSAS). METHODS A literature search was performed in the Cochrane Central Register of Controlled Trials, Web of Science, Scopus and PubMed databases from their inception to 31/03/2016, including available randomized controlled trials and controlled clinical trials published in English assessing the use of MRI integrated with traditional polysomnography (PSG) among children up to 15 years of age affected by OSAS. The primary outcome to be evaluated was the efficacy of MRI in analyzing the upper airway total volume among healthy children compared with children affected by OSAS. Secondary outcomes were to compare the efficacy of MRI in analyzing the upper airway cross-sectional area in the areas adjacent to the adenoids and tonsils, adenoid and tonsil volume, and soft-tissue and maxillofacial bone parameters in the same sample. Results were expressed using a random-effects model and mean differences (MD) with 95% confidence intervals (CI). RESULTS The search yielded 1005 titles in total; the selection process narrowed to 3 titles, which were all assessed as indicating an unclear level of risk of bias. The meta-analysis found evidence of MRI effectiveness in evaluating differences in the upper airway total volume between paediatric patients affected by OSAS and paediatric patients not affected by OSAS (MD -0.56 cm(3); 95% CI: -1.05 to -0.07). CONCLUSIONS Although MRI could be considered effective in evaluating upper airway structures in children affected by OSAS, based on the present evidence, PSG is still the golden standard and further studies are required to verify MRI reliability.
Collapse
Affiliation(s)
- Romeo Patini
- Dentistry Unit of Head and Neck
Clinical Area, School of Dentistry, Catholic University of Sacred Heart,
Rome, Italy
| | - Mariantonietta Arrica
- Department of Surgery,
Microsurgery and Medical Sciences, School of Dentistry, University of
Sassari, Sassari, Italy
| | - Enrico Di Stasio
- Molecular Clinical Biology Unit
of Laboratory Medicine Clinical Area, Catholic University of Sacred Heart,
Rome, Italy
| | - Patrizia Gallenzi
- Dentistry Unit of Head and Neck
Clinical Area, School of Dentistry, Catholic University of Sacred Heart,
Rome, Italy
| | - Massimo Cordaro
- Dentistry Unit of Head and Neck
Clinical Area, School of Dentistry, Catholic University of Sacred Heart,
Rome, Italy
| |
Collapse
|
15
|
Eslami E, Katz ES, Baghdady M, Abramovitch K, Masoud MI. Are three-dimensional airway evaluations obtained through computed and cone-beam computed tomography scans predictable from lateral cephalograms? A systematic review of evidence. Angle Orthod 2016; 87:159-167. [PMID: 27463700 DOI: 10.2319/032516-243.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To systematically review the literature correlating upper airway parameters between lateral cephalograms (LC) and cone-beam computed tomography (CBCT) or computed tomography (CT) scans to determine the utility of using LC to predict three-dimensional airway parameters. MATERIALS AND METHODS Both electronic and manual searches of the included studies were performed by two reviewers, and the quality of the studies that met selection criteria were assessed. RESULTS A total of 11 studies from the literature met the selection criteria. Assessed outcome variables showed correlation r < .7 between the LC and CT scans. The correlation between the LC and CBCT ranged from weak to strong with -.78 ≤ r and r ≤ .93 reported in the nasopharyngeal segment. In the oropharyngeal segment, a weak to strong correlation was reported with a range of -37 ≤ r and r ≤ .83 between the CBCT and LC. All associations in the hypopharyngeal segment showed a weak correlation. Four of studies were of weak quality, five were of moderate quality, and two were rated to be of strong quality. CONCLUSION No strong correlations were reported between the LC and CT scans. However, the LC-derived adenoid-nasopharyngeal ratio and the linear measurement (posterior nasal spine, PNS, to posterior pharyngeal wall) had a strong correlation with upright nasopharyngeal area and volume in the CBCTs. The area measurement in conventional LC can be also used as an initial screening tool to predict the upright three-dimensional oropharyngeal volumetric data. The variability of the hypopharyngeal segment cannot be predicted by LCs. However, more well-designed studies are needed to determine the clinical utility of using LC to predict airway size.
Collapse
|
16
|
Piccin CF, Pozzebon D, Scapini F, Corrêa ECR. Craniocervical Posture in Patients with Obstructive Sleep Apnea. Int Arch Otorhinolaryngol 2016; 20:189-95. [PMID: 27413397 PMCID: PMC4942290 DOI: 10.1055/s-0036-1584295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/18/2016] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep. OBJECTIVE The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI). METHODS This case-control study evaluated 21 subjects with OSA, who comprised the OSA group (OSAG), and 21 healthy subjects, who constituted the control group (CG). Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry. RESULTS The groups were homogeneous regarding gender (12 men and 9 women in each group), age (OSAG = 41.86 ± 11.26 years; GC = 41.19 ± 11.20 years), and body mass index (OSAG = 25.65 ± 2.46 kg/m2; CG = 24.72 ± 3.01 kg/m2). We found significant differences between the groups, with lower average pharyngeal space and greater distance between the hyoid bone and the mandibular plane in OSAG, when compared with CG. A positive correlation was found between higher head hyperextension and head anteriorization, with greater severity of OSA as assessed by AHI. CONCLUSION OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization.
Collapse
Affiliation(s)
- Chaiane Facco Piccin
- Post-graduate Programa in Human Communication Disorders, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Daniela Pozzebon
- Post-graduate Programa in Human Communication Disorders, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Fabricio Scapini
- Post-graduate Programa in Human Communication Disorders, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | | |
Collapse
|
17
|
Change in the Upper Airway of Patients With Obstructive Sleep Apnea Syndrome Using Computational Fluid Dynamics Analysis. J Craniofac Surg 2015; 26:e765-70. [DOI: 10.1097/scs.0000000000002209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
18
|
Soni J, Shyagali TR, Bhayya DP, Shah R. Evaluation of Pharyngeal Space in Different Combinations of Class II Skeletal Malocclusion. Acta Inform Med 2015; 23:285-9. [PMID: 26635436 PMCID: PMC4639349 DOI: 10.5455/aim.2015.23.285-289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives: The study was aimed to evaluate the pharyngeal airway linear measurements of untreated skeletal class II subjects with normal facial vertical pattern in prognathic maxilla with orthognathic mandible and orthognathic maxilla with retrognathic mandible. Materials and method: the sample comprised of lateral Cephalograms of two groups (30 each) of class II malocclusion variants. Group 1 comprised of class II malocclusion with prognathic maxilla and orthognathic mandible, whereas group 2 comprised of class II malocclusion with orthognathic maxilla and retrognathic mandible. Each group was traced for the linear measurements of the pharyngeal airway like the oropharynx, nasopharynx and soft palate. The obtained data was subjected to independent t test and the Mann Whitney test to check the difference between the two groups and within the groups respectively. Results: there was significant difference between all the linear measurements at the soft palate region and the distance between the tip of soft palate to its counter point on the pharyngeal wall in oropharynx region (p-ppm). Conclusion: the pharyngeal airway for class II malocclusion with various combination in an average growth pattern adult showed significant difference. The present results suggested, that the pharyngeal airway space might be the etiological factor for different sagittal growth pattern of the jaws and probable usage of different growth modification appliance can influence the pharyngeal airway.
Collapse
Affiliation(s)
- Jay Soni
- Department of Orthodontics and Dentofacial Orthopedics, Ahmedabad Dental College, Gujarat, India
| | - Tarulatha R Shyagali
- Department Of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, India
| | - Deepak P Bhayya
- Department of Pediatric and Preventive Dentistry, Hitkarini Dental College and Hospital, Jabalpur, India
| | - Romil Shah
- Department of Orthodontics, K.M. Shah Dental College, Vadodara, Gujarat, India
| |
Collapse
|
19
|
Armalaite J, Lopatiene K. Lateral teleradiography of the head as a diagnostic tool used to predict obstructive sleep apnea. Dentomaxillofac Radiol 2015; 45:20150085. [PMID: 26234535 DOI: 10.1259/dmfr.20150085] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To (1) assess the relationship between obstructive sleep apnea (OSA) and craniofacial, pharyngeal anatomy and (2) to submit the recommendations for clinicians for increasing the sensitivity in the diagnostics of OSA. METHODS A review of the relevant literature linking OSA in adults with cephalometric analysis was performed. In total, 11 articles with similar procedural criteria were selected. The data were analysed using the Comprehensive Meta-Analysis Software (Biostat Inc., Englewood, NJ) and Statistica 12.0 (StatSoft Inc., Dell Software, Tulsa, OK). RESULTS Adults with OSA did not show statistically significant differences in the sagittal and vertical skeletal planes in comparison with the controls (p > 0.05). The patients with OSA had soft palate length, width and area increased accordingly by 4.21, 1.99 mm and 0.86 cm(2), tongue area increased by 2.02 cm(2), the upper posterior pharyngeal space (SPAS) and lower posterior pharyngeal space reduced accordingly by 4.53 and 1.32 mm, mandibular plane to the hyoid bone (MP-H) distance increased by 4.14 mm compared with the controls (p < 0.05). The SPAS parameter of the patients with OSA did not show statistically significant differences between the studies, with the mean value being 5.69 mm. CONCLUSIONS Analysed cephalometric data totally supported the concept of soft-tissue abnormalities in subjects with OSA, skeletal-only halfway; MP-H and SPAS being the most reliable parameters. Increased MP-H may serve as a predictor when differentiating normal subjects and patients with OSA. Reduced SPAS width could be a prognostic parameter for suspecting OSA. These two values should be kept in mind by dentists and can also be used as a simple auxiliary method by physicians; nevertheless, it is still underestimated and more studies are needed.
Collapse
Affiliation(s)
- Juste Armalaite
- 1 Faculty of Odontology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Lopatiene
- 2 Clinic of Orthodontics, Faculty of Odontology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
20
|
Chen X, Wang R, Lutsey PL, Zee PC, Javaheri S, Alcántara C, Jackson CL, Szklo M, Punjabi N, Redline S, Williams MA. Racial/ethnic differences in the associations between obesity measures and severity of sleep-disordered breathing: the Multi-Ethnic Study of Atherosclerosis. Sleep Med 2015; 26:46-53. [PMID: 26459687 DOI: 10.1016/j.sleep.2015.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/25/2015] [Accepted: 06/01/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate associations between obesity measures and sleep-disordered breathing severity among White, Black, Hispanic, and Chinese Americans. METHODS The method used in this study was a community-based cross-sectional study of 2053 racially/ethnically diverse adults in the Multi-Ethnic Study of Atherosclerosis. Anthropometry and polysomnography were used to measure obesity and apnea-hypopnea index (AHI). Linear regression models were fitted to investigate associations of body mass index (BMI) and waist circumference with AHI (log transformed) with adjustment for sociodemographics, lifestyle factors, and comorbidities. RESULTS The mean participant age was 68.4 (range: 54-93) years; 53.6% of participants were women. The median AHI was 9.1 events/h. There were significant associations of BMI and waist circumference with AHI in the overall cohort and within each racial/ethnic group. A significant interaction was observed between race/ethnicity and BMI (Pinteraction = 0.017). Models predicted that for each unit increase in BMI (kg/m2), the mean AHI increased by 19.7% for Chinese, 11.6% for Whites and Blacks, and 10.5% for Hispanics. Similarly, incremental changes in waist circumference were associated with larger increases in AHI among Chinese than among other groups. CONCLUSIONS Associations of BMI and waist circumference with AHI were stronger among Chinese than among other racial/ethnic groups. These findings highlight a potential emergence of elevated sleep-disordered breathing prevalence occurring in association with increasing obesity in Asian populations.
Collapse
Affiliation(s)
- Xiaoli Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Rui Wang
- Department of Medicine, Harvard Medical School; Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Pamela L Lutsey
- Division of Epidemiology, Community Health University of Minnesota, Minneapolis, MN 55454, USA
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Sogol Javaheri
- Department of Medicine, Harvard Medical School; Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Carmela Alcántara
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Chandra L Jackson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Harvard Catalyst, Clinical and Translational Science Center, Harvard Medical School, Boston, MA 02115, USA
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Naresh Punjabi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School; Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| |
Collapse
|
21
|
Kim DK, Choi J, Kim KR, Hwang KG, Ryu S, Cho SH. Rethinking AASM guideline for split-night polysomnography in Asian patients with obstructive sleep apnea. Sleep Breath 2015; 19:1273-7. [DOI: 10.1007/s11325-015-1158-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/16/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
|
22
|
Sutherland K, Cistulli PA. Recent advances in obstructive sleep apnea pathophysiology and treatment. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Kate Sutherland
- Department of Respiratory and Sleep Medicine; Center for Sleep Health and Research; Royal North Shore Hospital; University of Sydney; Sydney New South Wales Australia
- Discipline of Sleep Medicine; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Woolcock Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine; Center for Sleep Health and Research; Royal North Shore Hospital; University of Sydney; Sydney New South Wales Australia
- Discipline of Sleep Medicine; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
23
|
Kim T, Baek SH, Choi JY. Effect of posterior impaction and setback of the maxilla on retropalatal airway and velopharyngeal dimensions after two-jaw surgery in skeletal Class III patients. Angle Orthod 2014; 85:625-30. [PMID: 25297469 DOI: 10.2319/041614-281.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the changes in retropalatal airway and velopharyngeal dimensions after posterior impaction (PI) only or PI and setback (PI/SB) of the maxilla in patients with skeletal Class III undergoing two-jaw surgery. MATERIALS AND METHODS Subjects consisted of 60 Class III patients treated with two-jaw surgery. They were divided into two groups: group 1 (n = 30; PI of the maxilla; mean = 2.6 mm) and group 2 (n = 30; PI/SB of the maxilla; mean = 2.8 mm and 1.8 mm, respectively). Using three dimensional computed tomography images taken 1month before surgery (T0) and at least 6 months after surgery (T1), retropalatal airway volume, minimum cross-sectional area, and lateral and anteroposterior (AP) dimensions of minimum cross-sectional area, soft palate angle, soft palate length, and pharyngeal depth were measured. A paired t-test and independent t-test were used for statistical analysis. RESULTS Group 1 showed increase in retropalatal airway volume and minimum cross-sectional area (P < .01 and P < .05, respectively). Group 2 exhibited decrease in retropalatal airway volume, minimum cross-sectional area, and lateral and AP dimensions of minimum cross-sectional area (all P < .01). Although groups 1 and 2 showed an increase in soft palate length (P < .01 and P < .001, respectively), pharyngeal depth significantly increased only in group 1 (P < .01). Groups 1 and 2 were significantly different in retropalatal airway volume, minimum cross-sectional area, and AP dimension (P < .05, P < .001, and P < .05, respectively). CONCLUSION Because the direction of surgical movement in the maxilla can determine the changes in the retropalatal airway and velopharyngeal dimensions, it is recommended that clinicians investigate whether patients suffer from sleep-related breathing disorders before performing PI/SB of the maxilla.
Collapse
Affiliation(s)
- Taeyun Kim
- a Graduate student (PhD), Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Seung-Hak Baek
- b Professor, Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Jin-Young Choi
- c Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
| |
Collapse
|
24
|
Wang T, Yang Z, Yang F, Zhang M, Zhao J, Chen J, Li Y. A three dimensional study of upper airway in adult skeletal Class II patients with different vertical growth patterns. PLoS One 2014; 9:e95544. [PMID: 24755893 PMCID: PMC3995783 DOI: 10.1371/journal.pone.0095544] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 03/28/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The study was performed to compare the 3D pharyngeal airway dimensions in adult skeletal Class II patients with different vertical growth patterns (low, normal, and high angle) and to investigate whether the upper airway dimensions of untreated skeletal Class II adults were affected by vertical skeletal variables. METHODS Cone-beam computed tomography (CBCT) records of 64 untreated adult skeletal Class II patients (34 male and 30 female) were collected to evaluate the pharyngeal airway dimensions. Subjects were divided into three subgroups according to the GoGn-SN angle (low angle, normal angle or high angle). All subgroups were matched for sex. ANOVA and SNK-q tests were used to identify differences within and among groups (p<0.05). Coefficient of product-moment correlation (Pearson correlation coefficient) was used to analyze the association between pharyngeal airway dimensions and vertical growth patterns. RESULTS The results showed that pharyngeal airway measurements were statistically significantly less (p<0.05) in high angle group as compared to normal angle or low angle group. CONCLUSIONS Adult skeletal Class II subjects with vertical growth patterns have significantly narrower pharyngeal airways than those with normal or horizontal growth patterns, confirming an association between pharyngeal airway measurements and a vertical skeletal pattern.
Collapse
Affiliation(s)
- Tianhu Wang
- State Key Laboratory of Military Stomatology, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China
| | - Zhenhua Yang
- State Key Laboratory of Military Stomatology, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China
| | - Fang Yang
- State Key Laboratory of Military Stomatology, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China
| | - Mingye Zhang
- State Key Laboratory of Military Stomatology, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China
| | - Jinlong Zhao
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China
| | - Jinwu Chen
- State Key Laboratory of Military Stomatology, Department of Radiology and Intervention Therapy, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China
| | - Yongming Li
- State Key Laboratory of Military Stomatology, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China
- * E-mail:
| |
Collapse
|
25
|
Fakhry N, Puymerail L, Michel J, Santini L, Lebreton-Chakour C, Robert D, Giovanni A, Adalian P, Dessi P. Analysis of Hyoid Bone Using 3D Geometric Morphometrics: An Anatomical Study and Discussion of Potential Clinical Implications. Dysphagia 2013; 28:435-45. [DOI: 10.1007/s00455-013-9457-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
|
26
|
Sutherland K, Lee RWW, Cistulli PA. Obesity and craniofacial structure as risk factors for obstructive sleep apnoea: impact of ethnicity. Respirology 2012; 17:213-22. [PMID: 21992683 DOI: 10.1111/j.1440-1843.2011.02082.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OSA is the result of structural and functional abnormalities that promote the repetitive collapse of the upper airway during sleep. This common disorder is estimated to occur in approximately 4% of men and 2% of women, with prevalence studies from North America, Australia, Europe and Asia indicating that occurrence is relatively similar across the globe. Anatomical factors, such as obesity and craniofacial morphology, are key determinants of the predisposition to airway collapse; however, their relative importance for OSA risk likely varies between ethnicities. Direct inter-ethnic studies comparing craniofacial phenotypes in OSA are limited. However, available data suggest that Asian OSA populations primarily display features of craniofacial skeletal restriction, African Americans display more obesity and enlarged upper airway soft tissues, while Caucasians show evidence of both bony and soft tissue abnormalities. Our recent comparison of Chinese and Caucasian OSA patients found for the same degree of OSA severity. Caucasians were more obese, and Chinese had more skeletal restriction. However, the ratio of obesity to craniofacial bony size (or anatomical balance, an important determinant of upper airway volume and OSA risk) was similar between Caucasians and Chinese OSA patients. Ethnicity appears to influence OSA craniofacial phenotype but furthermore the relative contribution of the anatomical factors underlying OSA risk. The skeletal restriction craniofacial phenotype may be particularly vulnerable to increasing obesity rates. Better understanding of craniofacial phenotypes encompassing ethnicity may help improve OSA recognition and treatment; however, further studies are needed to elucidate ethnic differences in OSA anatomical risk factors.
Collapse
Affiliation(s)
- Kate Sutherland
- Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia
| | | | | |
Collapse
|
27
|
Xiao Y, Chen X, Shi H, Yang Y, He L, Dong J, Kong W. Evaluation of airway obstruction at soft palate level in male patients with obstructive sleep apnea/hypopnea syndrome: Dynamic 3-dimensional CT imaging of upper airway. ACTA ACUST UNITED AC 2011; 31:413. [DOI: 10.1007/s11596-011-0392-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Indexed: 10/18/2022]
|
28
|
Zhang W, Song X, Masumi SI, Tanaka T, Zhu Q. Effects of head and body positions on 2- and 3-dimensional configuration of the oropharynx with jaw protruded: a magnetic resonance imaging study. ACTA ACUST UNITED AC 2011; 111:778-84. [DOI: 10.1016/j.tripleo.2011.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/29/2022]
|
29
|
Kim EJ, Choi JH, Kim YS, Kim TH, Lee SH, Lee HM, Shin C, Lee SH. Upper airway changes in severe obstructive sleep apnea: upper airway length and volumetric analyses using 3D MDCT. Acta Otolaryngol 2011; 131:527-32. [PMID: 21171831 DOI: 10.3109/00016489.2010.535561] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Three-dimensional multi-detector computed tomography (3D MDCT) analysis of the upper airway suggested that the lengthening of the upper airway in the absence of volumetric change may independently contribute to the severity of obstructive sleep apnea syndrome (OSAS) in adults. OBJECTIVES We sought to investigate the relationships among the length and volume of the upper airway to the severity of OSAS. METHODS A total of 73 subjects underwent 3D MDCT scanning and standard polysomnography. We measured the upper airway length (UAL), which was defined as the vertical distance from the hard palate to the hyoid in the mid-sagittal plane. We also used the height-adjusted UAL for analyses. Upper airway volume was measured using a 3D reconstruction of the cross-sectional area from the hard palate to the hyoid. RESULTS The adjusted UAL showed a significant positive correlation with the apnea hypopnea index (AHI, r = 0.523, p < 0.000) and was a significant variable for predicting the AHI of OSAS patients in multiple stepwise regression analysis. Although the severe OSAS group had a greater adjusted UAL compared with that of other groups (p = 0.001), the volume of the upper airway did not show differences among groups.
Collapse
Affiliation(s)
- Eun Joong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, 516 Gojan-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Lee RWW, Vasudavan S, Hui DS, Prvan T, Petocz P, Darendeliler MA, Cistulli PA. Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep 2010; 33:1075-80. [PMID: 20815189 PMCID: PMC2910536 DOI: 10.1093/sleep/33.8.1075] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To explore differences in craniofacial structures and obesity between Caucasian and Chinese patients with obstructive sleep apnea (OSA). DESIGN Inter-ethnic comparison study. SETTING Two sleep disorder clinics in Australia and Hong Kong. PATIENTS 150 patients with OSA (74 Caucasian, 76 Chinese). INTERVENTIONS Anthropometry, cephalometry, and polysomnography were performed and compared. Subgroup analyses after matching for: (1) body mass index (BMI); (2) OSA severity. MEASUREMENTS AND RESULTS The mean age and BMI were similar between the ethnic groups. Chinese patients had more severe OSA (AHI 35.3 vs 25.2 events/h, P = 0.005). They also had more craniofacial bony restriction, including a shorter cranial base (63.6 +/- 3.3 vs 77.5 +/- 6.7 mm, P < 0.001), maxilla (50.7 +/- 3.7 vs 58.8 +/- 4.3 mm, P < 0.001) and mandible length (65.4 +/- 4.2 vs 77.9 +/- 9.4 mm, P < 0.001). These findings remained after correction for differences in body height. Similar results were shown in the BMI-matched analysis (n = 66). When matched for OSA severity (n = 52), Chinese patients had more craniofacial bony restriction, but Caucasian patients were more overweight (BMI 30.7 vs 28.4 kg/m2, P = 0.03) and had a larger neck circumference (40.8 vs 39.1 cm, P = 0.004); however, the ratios of BMI to the mandible or maxilla size were similar. CONCLUSIONS Craniofacial factors and obesity contribute differentially to OSA in Caucasian and Chinese patients. For the same degree of OSA severity, Caucasians were more overweight, whereas Chinese exhibited more craniofacial bony restriction.
Collapse
Affiliation(s)
- Richard W. W. Lee
- Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital; Woolcock Institute of Medical Research; and University of Sydney, NSW, Australia
| | - Sivabalan Vasudavan
- Discipline of Orthodontics, Sydney Dental Hospital, University of Sydney, Australia
| | - David S. Hui
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Tania Prvan
- Department of Statistics, Macquarie University, NSW, Australia
| | - Peter Petocz
- Department of Statistics, Macquarie University, NSW, Australia
| | - M. Ali Darendeliler
- Discipline of Orthodontics, Sydney Dental Hospital, University of Sydney, Australia
| | - Peter A. Cistulli
- Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital; Woolcock Institute of Medical Research; and University of Sydney, NSW, Australia
| |
Collapse
|
31
|
Loredo JS, Soler X, Bardwell W, Ancoli-Israel S, Dimsdale JE, Palinkas LA. Sleep health in U.S. Hispanic population. Sleep 2010; 33:962-7. [PMID: 20614856 DOI: 10.1093/sleep/33.7.962] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The importance of sleep on health has only been recently recognized, and the general public and the medical community are not yet fully knowledgeable about this issue. The great majority of sleep research has been performed in whites of European descent and to a lesser extent in African Americans, making generalization of the findings to other ethnic and racial groups difficult. Very little sleep research has been done in U.S. Hispanics. However, based on the available literature and the high prevalence of risk factors in Hispanics, such as obesity, diabetes, living in the inner city, and use of alcohol, the prevalence of such important sleep disorders such as obstructive sleep apnea and sleep habits such as poor sleep hygiene are suspected to be high. There is also some evidence that acculturation to the U.S. life style may lead to worse sleep habits in Hispanics, including fewer hours of sleep. Two current large NIH sponsored studies of sleep in U.S. Hispanics promise to significantly add to the literature on various sleep disorders such as sleep disordered breathing, insomnia, restless legs syndrome, periodic limb movement disorder, and sleep habits such as short sleep duration and sleep hygiene.
Collapse
Affiliation(s)
- Jose S Loredo
- Department of Medicine, University of California, San Diego 92103-0804, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Lee RWW, Sutherland K, Cistulli PA. Craniofacial Morphology in Obstructive Sleep Apnea. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/cpm.0b013e3181e4bea7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Zhong Z, Tang Z, Gao X, Zeng XL. A comparison study of upper airway among different skeletal craniofacial patterns in nonsnoring Chinese children. Angle Orthod 2010; 80:267-74. [PMID: 19905851 DOI: 10.2319/030809-130.1] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients with OSAS (obstructive sleep apnea syndrome) demonstrate decreased upper airway dimension and craniofacial skeletal abnormalities. The study was performed to analyze whether upper airway dimensions differed among Chinese nonsnoring children of different sagittal and vertical skeletal facial morphologies. MATERIALS AND METHODS Lateral cephalometric records were used to measure the dimensions of the upper airway. Two groups of subjects were studied. A group of subjects with a normodivergent facial pattern (n = 190; FH-MP angle between 23.5 degrees and 30.5 degrees ) was divided into three subgroups according to ANB angle (Class I, II, or III). A second group of subjects with a normal sagittal facial pattern (n = 180; ANB angle between 0.7 degrees and 4.7 degrees ) was divided into three subgroups according to the FH-MP angle (low angle, normal angle, or high angle). All subgroups were matched for age and sex. RESULTS In the group of subjects with a normodivergent facial pattern, a significant tendency for reduced upper airway dimension in the inferior part (palatopharyngeal and hypopharynx) was found in the Class III, Class I, and Class II subgroups, in that order. In the group of subjects with a normal sagittal facial pattern, the superior part of the airway (nasopharyngeal and palatopharyngeal) decreased with increasing mandibular plane angle. CONCLUSION The sagittal and vertical skeletal patterns may be contributory factors for the variation of the inferior and superior part of the upper airway, respectively. Skeletal deficiency of nonsnoring Chinese children may predispose them to upper airway obstruction.
Collapse
Affiliation(s)
- Zhe Zhong
- Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing, People's Republic of China
| | | | | | | |
Collapse
|
34
|
Shigeta Y, Ogawa T, Tomoko I, Clark GT, Enciso R. Soft palate length and upper airway relationship in OSA and non-OSA subjects. Sleep Breath 2009; 14:353-8. [PMID: 19997779 DOI: 10.1007/s11325-009-0318-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 11/08/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND The narrowest area of the airway between the posterior nasal opening and the epiglottis is usually located in the retro palatal area. Many consider this the most likely site of airway obstruction during an obstructive sleep apnea (OSA) event. The aim of this study was to investigate the differences in soft palate and airway length between OSA and non-OSA patients. METHODS In this study, we analyzed the ratio of the soft palate and the upper airway length in 45 consecutive patients. Twenty-five had an Apnea-Hypoapnea Index of more than five events per hour and were classified in the OSA group (male, 19; female, 6). These patients were compared with 20 normal controls (male, 12; female, 8). Controls who complained of snoring did have sleep studies (n=5). The other fifteen controls were clinically asymptomatic and did not have sleep studies. Medical computed tomography scans were taken to determine the length of the upper airway and the soft palate length measured in the midsagittal image. RESULTS Soft palate length was significantly larger in OSA patients compared to controls (p=0.009), and in men compared to women (p=0.002). However, there were no differences in airway length. The soft palate length, as a percent of oropharyngeal airway length, was significantly larger in OSA patients compared to controls (p= <0.0001) and in men compared to women (p=0.02). Soft palate length increases significantly with age by 0.3 mm per year in males (after adjustment for body mass index (BMI) and OSA). Soft palate length as a percent of airway length is larger in OSA patients and increases significantly with BMI in males only after adjusting for age. CONCLUSION In this study, OSA patients had a longer soft palate in proportion to their oropharyngeal airway compared to controls as well as men compared to women. This proportion could be used for identifying patients at risk for OSA in combination with age.
Collapse
Affiliation(s)
- Yuko Shigeta
- Orofacial Pain/Oral Medicine Center, Division of Diagnostic Sciences, School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | | | | | | | | |
Collapse
|
35
|
Rao A, Tey BH, Ramalingam G, Poh AGH. Obstructive Sleep Apnoea (OSA) Patterns in Bariatric Surgical Practice and Response of OSA to Weight Loss after Laparoscopic Adjustable Gastric Banding (LAGB). ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n7p587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: This study aims to evaluate the incidence of Obstructive Sleep Apnoea (OSA) in severely obese Asians and to study the impact of weight loss on OSA.
Materials and Methods: We report the results of routine preoperative Polysomnograms in 350 Asian patients undergoing bariatric surgery in our institute. Polysomnograms were repeated in 75 randomly selected patients with moderate to severe OSA after target weight loss with the laparoscopically placed adjustable gastric band (LAGB).
Results: The prevalence of OSA in obese Asians is high. Moderate OSA was found in 46% of patients and severe OSA was found in 33%. Severe OSA was significantly more in the Chinese (46%) compared to the Malays (29%) or Indians (21%) (P = 0.035). We identified other risk factors for severe OSA (male sex, higher body mass index and the presence of hypertension) but were unable to select identifying parameters for very low (<5%) likelihood of severe OSA such that routine sleep studies prior to bariatric surgery could be omitted. Apnoea Hypoapnoea Index (AHI) showed improvement of 50% at 20 kg excess weight loss with the cure of OSA in preoperatively severe cases (P <0.005). Mild to moderate cases reported similar improvements although a direct correlation could not be established. Desaturation events, apnoea episodes, work of breathing and subjective assessment of sleepiness scores and quality of life (QOL) showed improving trends, albeit not statistically significant. Similar improvements were seen in sleep architecture with increased rapid eye movement (REM) and stage 3 sleep.
Conclusions: The incidence of OSA in Asians undergoing bariatric surgery is high. Routine sleep studies in Asian patients are justified. Weight loss brought about a significant improvement in AHI and continuous positive airway pressure requirements. LAGB placement should be considered a broadly effective therapy for sleep apnoea in the severely obese patient.
Introduction: This study aims to evaluate the incidence of Obstructive Sleep Apnoea (OSA) in severely obese Asians and to study the impact of weight loss on OSA.
Materials and Methods: We report the results of routine preoperative Polysomnograms in 350 Asian patients undergoing bariatric surgery in our institute. Polysomnograms were repeated in 75 randomly selected patients with moderate to severe OSA after target weight loss with the laparoscopically placed adjustable gastric band (LAGB).
Results: The prevalence of OSA in obese Asians is high. Moderate OSA was found in 46% of patients and severe OSA was found in 33%. Severe OSA was significantly more in the Chinese (46%) compared to the Malays (29%) or Indians (21%) (P = 0.035). We identified other risk factors for severe OSA (male sex, higher body mass index and the presence of hypertension) but were unable to select identifying parameters for very low (<5%) likelihood of severe OSA such that routine sleep studies prior to bariatric surgery could be omitted. Apnoea Hypoapnoea Index (AHI) showed improvement of 50% at 20 kg excess weight loss with the cure of OSA in preoperatively severe cases (P <0.005). Mild to moderate cases reported similar improvements although a direct correlation could not be established. Desaturation events, apnoea episodes, work of breathing and subjective assessment of sleepiness scores and quality of life (QOL) showed improving trends, albeit not statistically significant. Similar improvements were seen in sleep architecture with increased rapid eye movement (REM) and stage 3 sleep.
Conclusions: The incidence of OSA in Asians undergoing bariatric surgery is high. Routine sleep studies in Asian patients are justified. Weight loss brought about a significant improvement in AHI and continuous positive airway pressure requirements. LAGB placement should be considered a broadly effective therapy for sleep apnoea in the severely obese patient.
Collapse
Affiliation(s)
- A Rao
- Alexandra Hospital, Singapore
| | | | | | | |
Collapse
|
36
|
Banabilh SM, Suzina AH, Dinsuhaimi S, Samsudin AR, Singh GD. Craniofacial obesity in patients with obstructive sleep apnea. Sleep Breath 2008; 13:19-24. [DOI: 10.1007/s11325-008-0211-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 07/01/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
|
37
|
|
38
|
Degerliyurt K, Ueki K, Hashiba Y, Marukawa K, Nakagawa K, Yamamoto E. A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bimaxillary surgery or mandibular setback surgery. ACTA ACUST UNITED AC 2008; 105:495-502. [DOI: 10.1016/j.tripleo.2007.11.012] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 10/31/2007] [Accepted: 11/12/2007] [Indexed: 11/16/2022]
|
39
|
Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med 2008; 10:226-32. [PMID: 18387341 DOI: 10.1016/j.sleep.2008.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 11/28/2007] [Accepted: 01/21/2008] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Obesity is becoming more prevalent world wide. Bariatric surgery is one treatment option for patients with severe or morbid obesity. There have been few comprehensive studies examining prevalence and risk factors for obstructive sleep apnea (OSA) in the multiracial Singaporean bariatric surgery population. METHODS We performed full polysomnography on 176 consecutive patients undergoing assessment for bariatric surgery. Questionnaires regarding snoring, the presence of witnessed apneas and the Epworth Sleepiness Scale (ESS) were administered. Anthropometric and demographic measurements include age, sex, race, body mass index (BMI) and neck circumference. RESULTS The prevalence of OSA was 72%, and 49% of the 176 patients had an AHI >= 15. There was a male predominance of OSA (X(2) = 29.7; p<0.001). OSA subjects had larger neck circumference (43.9 +/- 4.5 vs. 39.4 cm +/- 3.3; p<0.001) and higher BMI (43.1 +/- 7.6 vs. 39.1 +/- 5.4 kg/m(2); p<0.001). The neck circumference (OR = 1.37; p<0.001), presence of snoring (OR = 8.25; p<0.001) and an ESS >10 (OR = 3.24; p = 0.03) were significant independent predictors of an AHI >= 15. A neck circumference of 43 cm had an 80% sensitivity and 83% specificity for predicting an AHI >= 15. CONCLUSIONS OSA is common amongst Singaporeans undergoing evaluation for bariatric surgery, with a high prevalence of moderate and severe disease. An increased neck circumference is a strong independent predictor for an AHI >= 15, with a neck circumference of greater than 43 cm being a sensitive and specific predictor. Race was not found to be a risk factor.
Collapse
|
40
|
Liu KH, Chu WCW, To KW, Ko FWS, Tong MWC, Chan JWS, Hui DS. Sonographic measurement of lateral parapharyngeal wall thickness in patients with obstructive sleep apnea. Sleep 2007; 30:1503-8. [PMID: 18041482 PMCID: PMC2082100 DOI: 10.1093/sleep/30.11.1503] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Lateral parapharyngeal wall (LPW) thickness may be a predominant anatomic factor causing airway narrowing in apneic subjects. In this study, we explored sonographic measurement of the LPW thickness and compared the results with LPW thickness measured by magnetic resonance imaging (MRI). We also investigated the association between sonographic measurement of LPW thickness and apnea-hypopnea index (AHI). METHOD Seventy-six patients with suspected obstructive sleep apnea (OSA) underwent ultrasound examination of LPW thickness after overnight polysomnography. Fifteen out of 76 subjects also participated in correlation and reliability studies of sonographic and MRI measurements of LPW thickness. RESULTS There was good correlation between measurements of LPW thickness on ultrasound and MRI (r = 0.78, P = 0.001), although Bland-Altman analysis indicated overestimation of LPW thickness by ultrasound, when compared with the LPW as measured by MRI. The sonographic measurement of LPW thickness had high reproducibility, with intraclass correlation coefficients of 0.90 and 0.97 for intraoperator and interoperator reliability, respectively. Fifty-eight subjects with significant OSA (AHI > or = 10/h) had a higher body mass index, larger neck circumference, and greater LPW thickness measured by ultrasound than those (n = 18) with an AHI of less than 10 per hour. LPW thickness had a positive correlation with AHI on univariate analysis (r = 0.37, P = 0.001). On multivariate analysis, LPW thickness had a positive independent association with AHI after adjustment for age, sex, neck circumference, and body mass index. The positive association of LPW thickness with AHI remained significant in both univariate and multivariate analyses of men only (n = 62). CONCLUSIONS Sonographic measurement of LPW thickness is a novel and reliable technique and had good correlations with measurement by MRI and the severity of OSA. Ultrasound may provide an alternative imaging modality with easy accessibility and lower cost in OSA research.
Collapse
Affiliation(s)
- Kin-Hung Liu
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
| | | | | | | | | | | | | |
Collapse
|
41
|
Jeong SJ, Kim WS, Sung SJ. Numerical investigation on the flow characteristics and aerodynamic force of the upper airway of patient with obstructive sleep apnea using computational fluid dynamics. Med Eng Phys 2007; 29:637-51. [PMID: 17049904 DOI: 10.1016/j.medengphy.2006.08.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 07/04/2006] [Accepted: 08/22/2006] [Indexed: 11/29/2022]
Abstract
Developing a mathematical model to predict the abnormal flow characteristics that are produced by obstructive sleep apnea is an important step in learning the pathophysiology of the obstructive sleep apnea (OSA) disease. The present study provides detailed calculations of flow in the pharyngeal airway of a patient with obstructive sleep apnea. To achieve this goal, a computational fluid dynamics model was constructed using raw data from three-dimensional computed tomogram (CT) images of an OSA patient. To reproduce the important transition from laminar to turbulent flow in the pharyngeal airway, the low Reynolds number k-epsilon model was adopted and successfully validated using previous open literature. The results show that the flow in the pharyngeal airway of patients with OSA comprises a turbulent jet formed by area restriction at the velopharynx. This turbulent jet causes higher shear and pressure forces in the vicinity of the velopharynx. From the results, It may be deduced that the most collapsible area in the pharyngeal airway of OSA patients is the velopharynx where minimum intraluminal pressure and maximum aerodynamic force lie.
Collapse
Affiliation(s)
- Soo-Jin Jeong
- Advanced Power & IT Research Center, Korea Automotive Technology Institute, Chonan, Chungnam 330-912, Republic of Korea
| | | | | |
Collapse
|
42
|
Lam B, Sam K, Mok WYW, Cheung MT, Fong DYT, Lam JCM, Lam DCL, Yam LYC, Ip MSM. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007; 62:354-9. [PMID: 17121868 PMCID: PMC2092459 DOI: 10.1136/thx.2006.063644] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 10/30/2006] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with mild to moderate obstructive sleep apnoea (OSA) may be managed with different treatment options. This study compared the effectiveness of three commonly used non-surgical treatment modalities. METHODS Subjects with mild to moderate OSA were randomised to one of three treatment groups for 10 weeks: conservative measures (sleep hygiene) only, continuous positive airways pressure (CPAP) in addition to conservative measures or an oral appliance in addition to conservative measures. All overweight subjects were referred to a weight-reduction class. OSA was assessed by polysomnography. Blood pressure was recorded in the morning and evening in the sleep laboratory. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. Health-related quality of life (HRQOL) was assessed with the 36-Item Short-Form Health Survey (SF-36) and Sleep Apnoea Quality of Life Index (SAQLI). RESULTS 101 subjects with a mean (SEM) apnoea-hypopnoea index (AHI) of 21.4 (1.1) were randomised to one of the three groups. The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group, and the CPAP group was significantly better than the oral appliance group. Relief from sleepiness was significantly better in the CPAP group. CPAP was also better than the oral appliance or conservative measures in improving the "bodily pain" domain, and better than conservative measures in improving the "physical function" domain of SF-36. Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI, although no difference was detected between the CPAP and oral appliance groups. CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values, but there was no difference in the changes in blood pressure between the groups. There was also a linear relationship between the changes in AHI and body weight. CONCLUSION CPAP produced the best improvement in terms of physiological, symptomatic and HRQOL measures, while the oral appliance was slightly less effective. Weight loss, if achieved, resulted in an improvement in sleep parameters, but weight control alone was not uniformly effective.
Collapse
Affiliation(s)
- Bing Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Johal A, Gill G, Ferman A, McLaughlin K. The effect of mandibular advancement appliances on awake upper airway and masticatory muscle activity in patients with obstructive sleep apnoea. Clin Physiol Funct Imaging 2007; 27:47-53. [PMID: 17204038 DOI: 10.1111/j.1475-097x.2007.00714.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is little understanding of how dental appliances, designed to posture the mandible forwards, act on pharyngeal airway dilatory and masticatory muscles in patients with obstructive sleep apnoea (OSA). This study evaluates, in a prospective cohort design, the effect of mandibular advancement splints (MAS) on awake genioglossus (GG), geniohyoid (GH) and masseter (M) muscle activity. METHODS Fifty OSA patients received a custom-made removable Herbst MAS appliance, adjusted for maximum therapeutic benefit, as judged by subjective improvement. Awake electromyographic (EMG) activity was recorded at baseline and with the MAS in situ, by using bipolar surface electrodes in patients seated upright and in the natural head position. The lower splint was modified to facilitate the placement of the intra-oral bipolar surface electrodes used to record GG EMG activity. RESULTS Significant increases in GG (P = 0.041), GH (P<0.001) and M (P<0.001) muscle activity accompanied placement of the MAS. CONCLUSIONS These findings support the contention of a physiological role, which may act to augment the anatomical action of MAS.
Collapse
Affiliation(s)
- Ama Johal
- Oral Growth and Development, Institute of Dentistry, Bart's and The London Queen Mary's School of Medicine and Dentistry, University of London, London, UK.
| | | | | | | |
Collapse
|
44
|
Kalra M, Chakraborty R. Genetic susceptibility to obstructive sleep apnea in the obese child. Sleep Med 2007; 8:169-75. [PMID: 17275401 DOI: 10.1016/j.sleep.2006.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 10/23/2022]
Abstract
The etiology of obstructive sleep apnea (OSA) is multifactorial, consisting of a complex interplay between anatomic and neuromuscular factors and an underlying genetic predisposition toward this disease. Several of the factors that have been reported to play a role in the pathogenesis of OSA can serve as intermediate phenotypes in investigations targeting genetic susceptibility to OSA. A precise underpinning of the genetic basis of OSA has been thus far difficult because it is still unknown whether or not the recognized candidate genes for OSA are directly causal to the phenotype, or whether their effects on OSA are mediated through the intermediate phenotypes of OSA. Future studies utilizing phenotypically homogenous groups such as those with childhood OSA and technological advances such as haplotype analysis in a case control design are extremely promising. Developing predictive models that incorporate genetic and phenotypic markers will enable early diagnosis and, therefore, intervention, ultimately resulting in reduction of morbidity and of the public health concerns associated with OSA in obese children.
Collapse
Affiliation(s)
- Maninder Kalra
- Cincinnati Children's Hospital, Division of Pulmonary Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, United States.
| | | |
Collapse
|
45
|
Hou HM, Hägg U, Sam K, Rabie ABM, Wong RWK, Lam B, Ip MS. Dentofacial Characteristics of Chinese Obstructive Sleep Apnea Patients in Relation to Obesity and Severity. Angle Orthod 2006; 76:962-9. [PMID: 17090158 DOI: 10.2319/081005-273] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 12/01/2005] [Indexed: 11/23/2022] Open
Abstract
Abstract
Objective: To evaluate dentofacial characteristics in relation to obesity and degree of severity of obstructive sleep apnea (OSA) in male Chinese patients and to elucidate the relationship between demographic parameters (age, body weight, height, and body mass index [BMI]) cephalometric parameters and OSA in these subjects.
Materials and Methods: Lateral cephalograms of 121 Chinese male patients in natural head posture were obtained. Based on BMI value, the patients were divided into three groups. Based on apnea-hypopnea index (AHI) value, the patients were divided into a mild-to-moderate and a severe group.
Results: The hyoid position and soft palate length were significantly different among the three obesity groups. Soft palate length was significantly longer (P < .01) in the severe OSA group than in the mild-to-moderate OSA group. Tongue base was significantly more inferiorly placed (P < .05) in the severe OSA group than in the mild-to-moderate OSA group. Craniocervical extension was significantly increased (P < .05) in the severe OSA group. Statistically significant differences were found among the three obesity groups in mandibular length, mandibular body length, maxillary length, anterior cranial base length, and overbite. The multiple stepwise linear regression analysis identified body weight, lower posterior facial height, mandibular body length, craniocervical extension, and sella-hyoid distance as the significant predictive variables for AHI.
Conclusions: This study revealed the existence of craniofacial and upper airway soft tissue differences in relation to obesity and severity of OSA among male Chinese OSA patients. Body weight and certain cephalometric parameters were significant predictors of OSA in Chinese male subjects.
Collapse
Affiliation(s)
- Huie Ming Hou
- Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
46
|
Shi H, Scarfe WC, Farman AG. Upper airway segmentation and dimensions estimation from cone-beam CT image datasets. Int J Comput Assist Radiol Surg 2006. [DOI: 10.1007/s11548-006-0050-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
Abstract
There is a scarcity of adult prevalence studies of OSA outside the Caucasian populations of North America, Europe and Australia, and comparisons have been complicated by methodological differences in sleep study settings, respiratory events definition, measured risk factors and clinical outcomes, and the lack of objective parameters for the measurement of ethnicity itself. Comparing studies with the same methodological design and respiratory events definition, recent large-scale prevalence studies from Hong Kong, Korea and India show similar OSA rates to populations of mainly Caucasian composition. OSA is a very complex disorder determined by several phenotypes such as obesity, craniofacial structure and abnormalities in neuromuscular and ventilatory control. Genetics may partially explain some of the ethnic clustering of these phenotypes, modulated by cultural and environmental factors. The exact contribution of these component phenotypes to overall OSA risk will be determined by their varying prevalence and relative risk conferred across ethnic groups. For lesser degrees of obesity, Asians are at risk for a more severe degree of illness compared with Caucasians. Inter-ethnic studies suggests that African-American ethnicity may also be a significant risk factor for OSA. The increased prevalences of OSA among American Indians and Hispanic adults, and increased severity among Pacific Islanders and Maoris, were mainly explained by increased obesity parameters. Most cephalometric studies have largely been conducted without specific regard to ethnicity and comparisons of findings across studies have been mainly limited by differences in sampling methods and the varying selection and definition of measured cephalometric variables. The limited number of studies with inter-ethnic comparative data suggest cephalometric variables and their degree of contribution to OSA vary across ethnic groups.
Collapse
Affiliation(s)
- Anna Tessa C Villaneuva
- Sleep Research Group, Woolcock Institute of Medical Research, University of Sydney, Australia
| | | | | | | |
Collapse
|
48
|
Sam K, Lam B, Ooi CG, Cooke M, Ip MS. Effect of a non-adjustable oral appliance on upper airway morphology in obstructive sleep apnoea. Respir Med 2005; 100:897-902. [PMID: 16219453 DOI: 10.1016/j.rmed.2005.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 06/01/2005] [Accepted: 08/10/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the effect of oral appliance (OA) on upper airway morphology and its relationship with treatment response in subjects with obstructive sleep apnoea (OSA). METHODS Symptomatic OSA subjects were recruited. Non-adjustable OA was custom made. Variables examined at baseline and while wearing the device at 2 months included polysomnographic data, computed tomographic measurements of upper airway cross sectional area at level of velopharynx (VA) and hypopharynx (HA), upper airway volume, and cephalometric parameters. Treatment outcome was based on post-treatment apnoea-hypopnoea index (AHI). RESULTS Forty patients were recruited and 23 (7 women) completed the study. They were middle-aged (49, 40-58 years) (median, interquartile range) and overweight (BMI 26, 23.3-29.5 kg/m2), with moderate OSA (AHI 26.4, 14.1-36). The overall post treatment AHI was 8.4 (2.4-12.5), with 14 (61%) patients showing good response (AHI<10), and the other 9 patients showing moderate response (>50% reduction in AHI but still 10). OA decreased the cross-sectional area of the HA (P=0.046), showed a trend of decreasing the ratio of cross-sectional area of the HA to cross-sectional area of the VA (P=0.053) and significantly increased the overall upper airway volume (P=0.006, n=11). No significant relationship between upper airway parameters and treatment outcome was identified. CONCLUSIONS OA altered upper airway morphometry towards a profile consistent with decreased propensity to collapse, which may thus have contributed to improvement of OSA.
Collapse
Affiliation(s)
- K Sam
- Orthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
| | | | | | | | | |
Collapse
|