Craniofacial morphology in Obstructive Sleep Apnea patients

Ten Years of Cone-Beam CT Airway Studies on Their Relationship with Different Anteroposterior Skeletal Patterns: A Systematic Review

Objectives: Given the widespread adoption of CBCT in clinical and research activity, it seems reasonable to critically evaluate the evidence produced on the investigations over the relationship between upper airway morphology and skeletal malocclusions patterns. Methods: The analysis method and inclusion criteria were pre-specified and documented in a protocol to minimize the risk of post hoc selective bias. A methodological quality grading system was used to identify the most valuable studies. Results: The nine selected articles, published between 2009 and 2020, involved subjects recruited from existing databases. The average methodological quality grading assessment score was 18.6 (range: minimum 16, maximum 23). Methodological quality scores ranged from 36.1% to 63.8% of the maximum possible score, with an average quality score of 51.1%. No high-quality studies were found in the sample. Conclusions: This systematic review revealed that no high-quality studies have compared upper airway morphology with skeletal patterns using cone-beam computed tomography. The heterogeneity of the results did not confirm strong evidence of a direct correlation between skeletal patterns and upper airway morphology. This appears to be due to a lack of consistency in CBCT protocols.

Airway Analysis and Morphometric Assessment of Dental Arches in Obstructive Sleep Apnea Patients

Background: Obstructive sleep apnea is a sleep-related breathing disorder associated with craniofacial morphology and dental arches. The aim of this study was to evaluate the correlation between obstructive sleep apnea and the morphometry of dental arches and upper airways. Methods: Forty patients were enrolled in the study, and the polysomnographic parameters evaluated were the apnea hypopnea index (AHI) and the oxygen desaturation index (ODI). Dental measurements taken from the 3D models included anterior arch widths, posterior arch widths, maxillary and mandibular arch lengths, and palatal surface area. A cone beam computed tomography (CBCT) evaluation was also performed. Results: In patients with moderate OSA, posterior maxillary width was significantly correlated with both minimal airway area (rho = 0.65, p < 0.01) and its transverse diameter (rho = 0.68, p < 0.01). Similarly, in patients with severe OSA, posterior maxillary width showed a significant correlation with total airway volume (rho = 1, p < 0.01), minimal airway area (rho = 1, p < 0.01), and its transverse diameter (rho = 1, p < 0.01). Conclusions: Craniofacial morphology and malocclusion can contribute to obstructive sleep apnea syndrome.

Altered cervical proprioception and biomechanics in obstructive sleep apnea: a case-control study

PURPOSE

This study aimed to compare cervical proprioception and related biomechanical factors among patients with Obstructive Sleep Apnea (OSA) and asymptomatic controls.

METHODS

In this case-control study, polysomnography scores (apnea-hypopnea index-AHI) were examined to determine the disease severity of the OSA group. Also, we evaluated cervical proprioception by using a laser pointer to detect joint repositioning error sense in cervical rotational movements. Comparison statistics were also conducted for the cervical musculoskeletal variables such as range of motion (ROM) with bubble inclinometer, cranio-cervical (CVA), and thoracic posture (TKA) through photometric analysis, neck flexor muscle endurance test, and pain pressure thresholds of trapezius (PPT).

RESULTS

This case-control study included 59 male participants: patients with OSA (n = 29; mean age = 49.10 years; mean BMI = 28.41 kg/m2) and asymptomatic controls (n = 30; mean age = 49.73 years; mean BMI = 26.89 ± 3.60 kg/m2). The mean AHI score was 26.06 events/hour, categorizing the severity of OSA as mild (31.03%), moderate (31.03%), and severe (37.94%). Patients with OSA demonstrated significantly poorer cervical proprioception compared to controls for both sides of cervical rotation with larger effect sizes (d:1.36-1.45; p < 0.05). Also, cervical ROM, CVA, TKA, neck flexor muscle endurance test, and PPT values were altered in the OSA group compared to the control group (p < 0.05).

CONCLUSION

Impaired cervical proprioception may be a previously unrecognized factor associated with OSA. This finding has implications for understanding the mechanisms underlying cervical musculoskeletal changes in OSA and for developing potential new interventions or exercise designs targeting postural control.

Evaluating Craniofacial Morphology Ratios as Predictors of Obstructive Sleep Apnea Severity in Non-Obese Adult Males

Background: This study aimed to examine the connection between craniofacial morphology, particularly the horizontal and vertical dimensions of the mandible, and the severity of obstructive sleep apnea (OSA) in non-obese adult males by utilizing a cephalometric analysis and introducing a new skeletal ratio index. Methods: A cohort of 44 non-obese adult males with OSA, diagnosed via the apnea-hypopnea index (AHI) from polysomnographic recordings, was evaluated using a lateral cephalometric analysis. OSA severity was classified as mild (5 ≤ AHI < 15) in 19 patients, moderate (15 ≤ AHI < 30) in 15 patients, and severe (AHI ≥ 30) in 10 patients. The S-Go distance divided by the N-Me distance (S-Go/N-Me) was used as a vertical ratio of craniofacial morphology, the Go-Me distance divided by the S-N distance (Go-Me/S-N) was used as a horizontal ratio, and the results were compared between groups. Correlations between each ratio and craniofacial morphology based on the five factors from the Ricketts analysis were examined for each group. Results: A significant difference was found in the horizontal ratio Go-Me/S-N between the mild and moderate groups (p < 0.05) and the mild and severe groups (p < 0.05). However, no significant differences in Ricketts analysis factors were observed across OSA severity groups. Correlations between the Go-Me/S-N and Ricketts factors were identified in the mild and moderate groups but not in the severe group. The horizontal skeletal dimension Go-Me/S-N was strongly associated with OSA severity. Conclusions: The horizontal mandibular ratio Go-Me/S-N, independent of body shape, may offer a valuable morphological marker for differentiating OSA severity in non-obese males.

Avoid overstepping the bounds of evidence: the role of the orthodontist in managing pediatric Obstructive Sleep Apnea

Introduction

Pediatric Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder often linked to distinct craniofacial features and malocclusions. While orthodontic treatments, particularly maxillary expansion and mandibular advancement, have been suggested for managing this condition, the results remain controversial and are based on low-quality evidence. This paper aims to summarize the ongoing debates on this topic by reviewing relevant literature and highlighting the role of the orthodontist in diagnosing and managing OSA in daily clinical practice.

Discussion and conclusions

According to the present review, there is insufficient evidence to either confirm or deny the effectiveness of oral appliances for treating pediatric OSA due to significant methodological limitations, such as small sample sizes, inadequate control groups, short study durations, and a lack of long-term follow-up. Additionally, this condition cannot be diagnosed solely based on craniofacial morphology, but an interdisciplinary evaluation is strictly required. In addition, orthopedic treatment may be considered only as an adjunct therapy for children with craniofacial anomalies increasing the risk for OSA, and the combination of multiple therapeutic approaches may be necessary to achieve effective treatment outcomes.

The role of orthodontists in the multidisciplinary management of obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) is a complex disorder characterized by interruptions in breathing during sleep, leading to a range of adverse outcomes from reduced quality of life to serious health risks, including cardiovascular diseases and increased mortality.

MAIN BODY

This manuscript reviews the orthodontists' essential role in the multidisciplinary healthcare team tasked with managing OSA. It particularly highlights critical orthodontic interventions, such as surgical-orthodontic maxillomandibular advancement (MMA), mandibular advancement appliances (MAAs), and rapid maxillary expansion (RME). These interventions are pivotal in modifying craniofacial structures to enhance airway patency. The importance of conducting a thorough airway analysis is underscored, assessing the complete anatomical and functional factors contributing to airway obstruction.

CONCLUSION

The paper calls for increased collaborative research efforts to develop standardized, evidence-based orthodontic procedures for effectively managing OSA, aiming to improve patient outcomes through specialized, tailored interventions.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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