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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.
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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
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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.
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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
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Wang X, Gong X, Yu Z, Gao X, Zhao Y. Follow-up study of dental and skeletal changes in patients with obstructive sleep apnea and hypopnea syndrome with long-term treatment with the Silensor appliance. Am J Orthod Dentofacial Orthop 2015; 147:559-65. [PMID: 25919101 DOI: 10.1016/j.ajodo.2015.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 01/01/2015] [Accepted: 01/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In this study, we aimed to investigate the dental and skeletal changes associated with long-term use of the Silensor appliance (Erkodent, Cologne, Germany) in patients with obstructive sleep apnea and hypopnea syndrome. METHODS The sample included 42 patients with mild-to-severe obstructive sleep apnea and hypopnea syndrome (mean apnea-hypopnea index, 27; range, 5-74) who had been treated with the Silensor appliance for an average of 4 years (range, 1-11 years). A questionnaire was used to assess of the side effects subjectively; the cephalometric analysis was conducted to identify the dental and skeletal changes of different treatment times objectively. RESULTS The Silensor appliance was associated with few subjective side effects. Most subjective side effects decreased after long-term use of the Silensor appliance. Significant changes after long-term use of the Silensor appliance were observed in incisor angulation, overbite, overjet, mandibular plane angle, anterior lower facial height, and anterior facial height. Overbite and skeletal changes at treatment times between 1 year and 3 years were a decrease in overbite and increases in the mandibular plane angle, anterior lower facial height, and anterior facial height. Overjet and other dental changes at treatment times longer than 3 years were a decrease in overjet, retroclination of the maxillary incisors, and proclination of the mandibular incisors. CONCLUSIONS The Silensor appliance was well tolerated and preferred by most subjects. Common but mild dental and skeletal changes resulted from using the appliance over a long period of time. The changes after 1 to 3 years of use were skeletal changes predominantly. Both dental and skeletal changes were observed simultaneously at treatment times longer than 3 years.
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Affiliation(s)
- Xiaoyu Wang
- Resident, Department of Dentistry, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Gong
- Lecturer, Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Zhe Yu
- Lecturer, Department of Dentistry, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuemei Gao
- Professor, Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Ying Zhao
- Professor, Department of Dentistry, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Lateral cephalometric analysis and the risks of moderate to severe obstructive sleep-disordered breathing in Thai patients. Sleep Breath 2013; 17:1249-55. [PMID: 23508488 DOI: 10.1007/s11325-013-0830-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/28/2013] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
PURPOSES This cross-sectional study was aimed to compare lateral cephalometric parameters among patients with different severities of obstructive sleep-disordered breathing and to determine if there are radiographic variables that increase risk of moderate to severe obstructive sleep apnea (OSA). METHODS Ten linear and 5 angular parameters of lateral cephalometry in 188 adult subjects which included 47 controls and 141 patients with OSA classified by apnea-hypopnea index (AHI) from level-I polysomnography, were analyzed. All radiographs were done under standardized processes and measured twice on separate occasions. RESULTS There were statistically significant differences between controls and patients with AHI ≥ 15 in parameters such as a distance from mandibular plane to hyoid (MP-H), posterior airway space (PAS), skull base angle (NSBA), a distance from posterior nasal spine to posterior pharyngeal wall (PNS-PP), and soft palate length (PNS-P), (p < 0.01). However, no significant difference was found between controls and mild OSA. Logistic regression analysis showed that only MP-H with cutoff point of ≥ 18 millimeters, NSBA ≤ 130°, and PAS ≤ 10 millimeters were independent cephalometric variables that increased risk of having AHI ≥ 15 compared to controls with adjusted odds ratio of 17.1, 8.3 and 4.2, respectively. Gender did not significantly associate with OSA severity in this analysis. CONCLUSIONS Patients who had longer MP-H, narrower PAS and narrower NSBA than specific cutoff points significantly increased risks of moderate to severe OSA. Treatments that effectively improve these parameters, particularly at tongue base level (MP-H and PAS), may decrease the severity of disease.
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Maurer JT. Early diagnosis of sleep related breathing disorders. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2010; 7:Doc03. [PMID: 22073090 PMCID: PMC3199834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Obstructive sleep apnea (OSA) being the most frequent sleep related breathing disorder results in non-restorative sleep, an increased cardiovascular morbidity and mortality as well as an elevated number of accidents. In Germany at least two million people have to be expected. If obstructive sleep apnea is diagnosed early enough then sleep may regain its restorative function, daytime performance may be improved and accident risk as well as cardiovascular risk may be normalised. This review critically evaluates anamnestic parameters, questionnaires, clinical findings and unattended recordings during sleep regarding their diagnostic accurracy in recognising OSA. There are numerous tools with insufficient results or too few data disqualifying them for screening for OSA. Promising preliminary results are published concerning neural network analysis of a high number of clinical parameters and non-linear analysis of oximetry itself or in combination with heart rate. Nasal pressure recordings can be used for risk estimation even without expertise in sleep medicine. More data is needed. Unattended portable monitoring used by qualified physicians is the gold standard procedure when screening methods for OSA are compared. It has a very high sensitivity and specificity well documented by several meta-analyses.
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Affiliation(s)
- Joachim T. Maurer
- Sleep Disorders Centre, University Dept. of Otorhinolaryngology, Head and Neck Surgery Mannheim, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Mannheim, Germany,*To whom correspondence should be addressed: Joachim T. Maurer, Sleep Disorders Centre, University Dept. of Otorhinolaryngology, Head and Neck Surgery Mannheim, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, 68135 Mannheim, Germany, Telephone: +49 (0)621 383 1600, Telefax: +49 (0)621 383 1972, E-mail:
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Correlation between the severity of sleep apnea and upper airway morphology in pediatric and adult patients. Curr Opin Allergy Clin Immunol 2010; 10:26-33. [DOI: 10.1097/aci.0b013e328334f659] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Stuck B, Maurer J. Der Stellenwert bildgebender Verfahren bei der obstruktiven Schlafapnoe. SOMNOLOGIE 2009. [DOI: 10.1007/s11818-009-0415-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hanggi MP, Teuscher UM, Roos M, Peltomaki TA. Long-term changes in pharyngeal airway dimensions following activator-headgear and fixed appliance treatment. Eur J Orthod 2008; 30:598-605. [DOI: 10.1093/ejo/cjn055] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the historical origins of modern cephalometry. 2. Identify common landmark points on the lateral cephalogram. 3. Describe multiple common clinical uses for cephalometry. 4. Exhibit knowledge of developments in imaging and analysis alternatives. BACKGROUND Interest in the dimensions of the human head has been present since antiquity. Proportional analysis and measures from cadaveric specimens led to the development of radiologic image capture and analysis on living subjects. These techniques were originally applied to establishing normative values, documenting growth, and diagnosing dentofacial disharmonies. This article reviews the origins of cephalometric methodology and current developments and applications. METHODS The authors conducted a MEDLINE search and review of all English language articles using the keywords "cephalometric" and "cephalometrics." RESULTS Cephalometrics have undergone substantial use and development since the introduction of radiologic imaging on living human subjects in 1931. Although frequently associated with orthognathic surgery, cephalometrics have been applied to a number of conditions involving altered craniofacial morphology. Advances in imaging and computing have led to increased interest in three-dimensional and non-x-ray-based assessment of the human head. Mathematical models have been applied to standard cephalometric information to increase the descriptive accuracy of the complex shapes involved. CONCLUSIONS Cephalometric techniques and analyses are versatile tools that can be applied to a wide variety of clinical scenarios involving the craniofacial region. New technologies and expanded applications promise to continue the development and use of this well-established methodology.
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Julià-Serdà G, Pérez-Peñate G, Saavedra-Santana P, Ponce-González M, Valencia-Gallardo JM, Rodríguez-Delgado R, Cabrera-Navarro P. Usefulness of cephalometry in sparing polysomnography of patients with suspected obstructive sleep apnea. Sleep Breath 2007; 10:181-7. [PMID: 17053929 DOI: 10.1007/s11325-006-0073-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this investigation was to evaluate the contribution of cephalometry to a statistical model integrating clinical, physical, and oximetric variables, to reduce demands for polysomnographies. Two hundred and twenty-five consecutive patients that had been referred to the sleep clinic for suspected obstructive sleep apnea (OSA) were studied. The clinical assessment of all patients consisted of a sleep related questionnaire, the Epworth sleepiness scale, and a physical examination. In addition, they all underwent spirometry, cephalometry, and a full polysomnography. The clinical variables related with OSA were questions concerning witnessing of apneas by bed partners, intensity of snoring, a history of hypertension, and nocturia. A significant relation was also found with score on the Epworth scale, sex, age, body mass index, neck and waist circumferences, total number and frequency of oxygen desaturations, and the lowest oxygen saturation value. Significant cephalometric measurements were: the linear distance from gonion to gnathion, from the hyoid bone to the mandibular plane, and from the posterior nasal spine to the tip of the soft palate, and the thickness of the uvula as well. A statistical model was built to estimate a patient's probability of having OSA based on clinical variables, physical examination, pulse oximetry, and cephalometry. The validation of this model demonstrated a remarkable ability in reducing the number of polysomnographic studies. We conclude that cephalometry combined with clinical variables, physical examination, and nocturnal oximetry is useful in the diagnosis of OSA and enables the sparing of a considerable number of polysomnographies.
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Affiliation(s)
- Gabriel Julià-Serdà
- Department of Pulmonary Medicine, Dr. Negrín Hospital, Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain.
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Abstract
The standard for the diagnosis of obstructive sleep apnea (OSA) is polysomnography (PSG). Although PSG helps identify individuals who have OSA and guides medical management, it does not identify the obstruction site or predict surgical results. Radiologic and diagnostic studies have been used to direct surgical intervention and predict outcomes of sleep apnea surgery. These studies include lateral cephalometric radiographs, CT, MRI, asleep fluoroscopy, asleep and awake endoscopy, upper airway manometry, and acoustic reflection techniques. The ideal diagnostic study would identify individuals who have OSA, be cost-effective and readily accessible, and guide therapeutic, site-specific intervention with predictable results. In this article, the various modalities are reviewed in terms of their capability to effectively diagnose and guide treatment of OSA.
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Affiliation(s)
- Kunal Thakkar
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, 1855 West Taylor Street, Room 3.87, Chicago, IL 60612, USA
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