The Link between Obstructive Sleep Apnea Syndrome and Cephalometric Assessment of Upper Airways and Hyoid Bone Position
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients’ Selection
2.2. Study Design
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Azarbarzin, A.; Sands, S.A.; Younes, M.; Taranto-Montemurro, L.; Sofer, T.; Vena, D.; Alex, R.M.; Kim, S.-W.; Gottlieb, D.J.; White, D.P.; et al. The Sleep Apnea-Specific Pulse-Rate Response Predicts Cardiovascular Morbidity and Mortality. Am. J. Respir. Crit. Care Med. 2021, 203, 1546–1555. [Google Scholar] [CrossRef] [PubMed]
- Barletta, P.; Abreu, A.R.; Ramos, A.R.; Dib, S.I.; Torre, C.; Chediak, A.D. Role of Obstructive Sleep Apnea in Cognitive Impairment. Int. J. Head Neck Surg. 2019, 10, 57–61. [Google Scholar] [CrossRef]
- Benjafield, A.V.; Ayas, N.T.; Eastwood, P.R.; Heinzer, R.; Ip, M.S.; Morrell, M.J.; Nunez, C.M.; Patel, S.R.; Penzel, T.; Pépin, J.L.; et al. Estimation of the global prevalence and burden of obstructive sleep apnea: A literature-based analysis. Lancet Respir. Med. 2019, 7, 687–698. [Google Scholar] [CrossRef]
- Tufik, S.; Santos-Silva, R.; Taddei, J.A.; Bittencourt, L.R. Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study. Sleep Med. 2010, 11, 441–446. [Google Scholar] [CrossRef] [PubMed]
- Mehra, R.; Gharibeh, T. Obstructive sleep apnea syndrome: Natural history, diagnosis, and emerging treatment options. Nat. Sci. Sleep 2010, 2, 233–255. [Google Scholar] [CrossRef] [PubMed]
- Farhana, G.; Mubassar, F.; Attiya, S. Change in the position of hyoid bone with functional appliance treatment. J. Pak. Dent. Assoc. 2010, 19, 19–23. [Google Scholar]
- Lyberg, T.; Krogstad, O.; Djupesland, G. Cephalometric analysis in patients with obstructive sleep apnoea syndrome: I. Skeletal morphology. J. Laryngol. Otol. 1989, 103, 287–292. [Google Scholar] [CrossRef]
- Kushida, C.A.; Littner, M.R.; Hirshkowitz, M.; Morgenthaler, T.I.; Alessi, C.A.; Bailey, D.; Boehlecke, B.; Brown, T.M.; Coleman, J., Jr.; Friedman, L.; et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 2006, 29, 375–380. [Google Scholar] [CrossRef]
- Laxmi, N.V.; Talla, H.; Meesala, D.; Soujanya, S.; Naomi, N.; Poosa, M. Importance of cephalograms in diagnosis of patients with sleep apnea. Contemp. Clin. Dent. 2015, 6 (Suppl. S1), S221–S226. [Google Scholar] [CrossRef]
- Kwentus, J.; Schulz, S.C.; Fairman, P.; Isrow, L. Sleep apnea: A review. Psychosomatics 1985, 26, 713–724. [Google Scholar] [CrossRef]
- Bharadwaj, R.; Krishnaswamy, N.; Ravikumar, A. Evaluation of craniofacial morphology in patients with obstructive sleep apnea using lateral cephalometry and dynamic MRI. Indian J. Dent. Res. 2011, 22, 739–748. [Google Scholar] [CrossRef] [PubMed]
- Vidović, N.; Mestrović, S.; Dogas, Z.; Buković, D.; Brakus, I.; Brakus, R.B.; Kovacić, I. Craniofacial morphology of Croatian patients with obstructive sleep apnea. Coll. Antropol. 2013, 37, 271–279. [Google Scholar] [PubMed]
- Johns, M.W. A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep 1991, 14, 540–545. [Google Scholar] [CrossRef]
- Chung, F.; Abdullah, H.R.; Liao, P. STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest 2016, 149, 631–638. [Google Scholar] [CrossRef] [PubMed]
- Chiu, H.Y.; Chen, P.Y.; Chuang, L.P.; Chen, N.H.; Tu, Y.K.; Hsieh, Y.J.; Wang, Y.C.; Guilleminault, C. Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis. Sleep Med. Rev. 2017, 36, 57–70. [Google Scholar] [CrossRef]
- Nagappa, M.; Liao, P.; Wong, J.; Auckley, D.; Ramachandran, S.K.; Memtsoudis, S.; Mokhlesi, B.; Chung, F. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: A systematic review and meta-analysis. PLoS ONE 2015, 10, e0143697. [Google Scholar] [CrossRef]
- Bayat, M.; Shariati, M.; Rakhshan, V.; Abbasi, M.; Fateh, A.; Sobouti, F.; Davoudmanesh, Z. Cephalometric risk factors of obstructive sleep apnea. CRANIO® 2016, 35, 321–326. [Google Scholar] [CrossRef]
- Varma, N.K.S.; Ghosh, P.; Ajith, V.V.; Prabha, R.D.; Raj, M. Epidemiological study on prevalent risk factors and craniofacial skeletal patterns in obstructive sleep apnea among South Indian population. Indian J. Dent. Res. 2020, 31, 784–790. [Google Scholar] [CrossRef]
- Neelapu, B.C.; Kharbanda, O.P.; Sardana, H.K.; Balachandran, R.; Sardana, V.; Kapoor, P.; Gupta, A.; Vasamsetti, S. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Med. Rev. 2017, 31, 79–90. [Google Scholar] [CrossRef]
- Available online: https://www.carestreamdental.com/en-us/csd-products/extraoral-imaging/cephalometric-imaging/ (accessed on 5 July 2020).
- Armalaite, J.; Lopatienė, K. Lateral teleradiography of the head as a diagnostic tool used to predict obstructive sleep apnea. Dentomaxillofac. Radiol. 2016, 45, 20150085. [Google Scholar] [CrossRef]
- Valarelli, L.P.; Corradi, A.M.; Grechi, T.H.; Eckeli, A.L.; Aragon, D.C.; Küpper, D.S.; Almeida, L.A.; Sander, H.H.; De Felício, C.M.; Trawitzki, L.V.V.; et al. Cephalometric, muscular and swallowing changes in patients with OSAS. J. Oral Rehabil. 2018, 45, 692–701. [Google Scholar] [CrossRef] [PubMed]
- Zucconi, M.; Ferini-Strambi, L.; Palazzi, S.; Orena, C.; Zonta, S.; Smirne, S. Habitual snoring with and without obstructive sleep apneea: The importance of cephalometric variables. Thorax 1992, 47, 157–161. [Google Scholar] [CrossRef]
- Maltais, F.; Carrier, G.; Cormier, Y.; Series, F. Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea. Thorax 1991, 46, 419–423. [Google Scholar] [CrossRef] [PubMed]
- Peppard, P.E.; Young, T.; Palta, M.; Dempsey, J.; Skatrud, J. Longitudinal Study of Moderate Weight Change and Sleep-Disordered Breathing. JAMA 2000, 284, 3015–3021. [Google Scholar] [CrossRef]
- Tishler, P.V.; Larkin, E.K.; Schluchter, M.D.; Redline, S. Incidence of sleep-disordered breathing in an urban adult population: The relative importance of risk factors in the development of sleep-disordered breathing. JAMA 2003, 289, 2230–2237. [Google Scholar] [CrossRef]
- Newman, A.B.; Foster, G.; Givelber, R.; Nieto, F.J.; Redline, S.; Young, T. Progression and regression of sleep-disordered breathing with changes in weight: The Sleep Heart Health Study. Arch. Intern. Med. 2005, 165, 2408–2413. [Google Scholar] [CrossRef]
- Silva, V.G.; Pinheiro, L.A.; Silveira, P.L.; Duarte, A.S.M.; Faria, A.C.; Carvalho, E.G.P.; Zacanella, E.; Crespo, A.N. Corelation between cephalometric data and severity of sleep apneea. Braz. J. Otorhinolaryngol. 2014, 80, 191–195. [Google Scholar] [CrossRef] [PubMed]
- Riha, R.L.; Brander, P.; Vennelle, M.; Douglas, N.J. A cephalometric comparison of patients with the sleep apnea/hypopnea syndrome and their siblings. Sleep 2005, 28, 315–320. [Google Scholar]
- Kitamura, T.; Sakabe, A.; Ueda, N.; Shiomori, T.; Udaka, T.; Ohbuchi, T.; Suzuki, H. Usefulness of cephalometry and pharyngeal findings in the primary diagnosis of obstructive sleep apnea syndrome. J. Otolaryngol. Jpn. 2008, 111, 695–700. [Google Scholar]
- Cillo, J.E.; Thayer, S.; Dasheiff, R.M.; Finn, R. Relations between obstructive sleep apnea syndrome and specific cephalometric measurements, body mass index, and apnea-hypopnea index. J. Oral Maxillofac. Surg. 2012, 70, e278–e283. [Google Scholar] [CrossRef]
- Horner, R.L.; Mohiaddin, R.H.; Lowell, D.G.; Shea, S.A.; Burman, E.D.; Longmore, D.B.; Guz, A. Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnea and weight matched controls. Eur. Respir. J. 1989, 2, 613–622. [Google Scholar] [PubMed]
- Koenig, J.S.; Thach, B.T. Effects of mass loading on the upper airway. J. Appl. Physiol. 1988, 64, 2294–2299. [Google Scholar] [CrossRef] [PubMed]
- Kushida, C.A. Obstructive Sleep Apnea: Pathophysiology, Comorbidities and Consequences; CRC Press, Taylor & Francis Group: Boca Raton, FL, USA, 2007; Volume 3, pp. 11, 24, 199, 201, 206, 209, 210, 211, 213, 263, 264, 266. [Google Scholar]
- Riley, R.W.; Powell, N.B.; Guilleminault, C. Inferior mandibular osteotomy and hyoid myotomy suspension for obstructive sleep apnea: A review of 55 patients. J. Oral Maxillofac. Surg. Off. J. Am. Assoc. Oral Maxillofac. Surg. 1989, 47, 159–164. [Google Scholar] [CrossRef]
- Schwartz, A.R.; Gold, A.R.; Schubert, N.; Stryzak, A.; Wise, R.A.; Permutt, S.; Smith, P.L. Effect of Weight Loss on Upper Airway Collapsibility in Obstructive Sleep Apnea. Am. Rev. Respir. Dis. 1991, 144, 494–498. [Google Scholar] [CrossRef] [PubMed]
- Brooks, L.J.; Strohl, K.P. Size and Mechanical Properties of the Pharynx in Healthy Men and Women. Am. Rev. Respir. Dis. 1992, 146, 1394–1397. [Google Scholar] [CrossRef]
- Mohsenin, V. Gender differences in the expression of sleep-disordered breathing: Role of upper airway dimensions. Chest 2001, 120, 1442–1447. [Google Scholar] [CrossRef]
- Brown, I.G.; Zamel, N.; Hoffstein, V. Pharyngeal cross-sectional area in normal men and women. J. Appl. Physiol. 1986, 61, 890–895. [Google Scholar] [CrossRef]
- Martin, S.; Mathur, R.; Marshall, I.; Douglas, N. The effect of age, sex, obesity and posture on upper airway size. Eur. Respir. J. 1997, 10, 2087–2090. [Google Scholar] [CrossRef] [Green Version]
Airway Evaluation | |
---|---|
Measurements | Explanations |
AD1 | Adenoid point 1 (adenoid tissue on the PNS-Ba line) |
AD2 | Adenoid point 2 (adenoid tissue on the midpoint between sella and basion to PNS line) |
PNS-AD1 | Lower nasopharyngeal airway space (width of airway along PNS-Ba line) |
PNS-AD2 | Upper nasopharyngeal airway space (width of airway along PNS-R line) |
SPAS | Superior posterior airway space(width of airway behind soft palate along parallel line to palatal plane) |
MAS | Middle airway space (with of airway along parallel line to palatal plane trough Sp) |
IAS | Inferior airway space (width of airway along parallel line to palatal plane through epiglottis tip) |
Hyoid Bone Evaluation | |
---|---|
Measurements | Explanation |
H-B | Distance from H to point B |
H-MnP | Distance from H to mandibular plane (Go-Me) |
H-C3 | Distance from H to C3 |
95 CI for Mean | |||||
---|---|---|---|---|---|
Mean | SD | Lower Bound | Upper Bound | ||
Age | OSAS Group | 41.88 | 10.94 | 37.26 | 46.49 |
Control Group | 29.33 | 11.87 | 24.32 | 34.34 |
Comparison of OSAS and Control Groups (Airway Space Evaluation) | |||||
---|---|---|---|---|---|
Mean | Std. Deviation | Std. Error Mean | Sig. (2-Tailed) | ||
PNS-AD2 | Control group | 21.28 | 5.57 | 1.14 | 0.670 |
OSAS group | 21.84 | 3.37 | 0.69 | ||
PNS-AD1 | Control group | 37.15 | 3.41 | 0.70 | 0.230 |
OSAS group | 34.93 | 8.17 | 1.67 | ||
SPAS | Control group | 12.20 | 3.34 | 0.68 | 0.030 |
OSAS group | 10.32 | 2.44 | 0.50 | ||
MAS | Control group | 10.96 | 3.44 | 0.70 | 0.000 |
OSAS group | 7.96 | 1.59 | 0.33 | ||
IAS | Control group | 10.97 | 3.89 | 0.79 | 0.830 |
OSAS group | 11.17 | 2.31 | 0.47 |
Comparison of OSAS and Control Groups (Hyoid Bone Evaluation) | |||||
---|---|---|---|---|---|
Mean | Std. Deviation | Std. Error Mean | Sig. (2-Tailed) | ||
H-B | Control group | 50.96 | 5.11 | 1.04 | 0.000 |
OSAS group | 60.05 | 4.36 | 0.89 | ||
H-MnP | Control group | 16.17 | 5.83 | 1.19 | 0.000 |
OSAS group | 26.31 | 5.34 | 1.09 | ||
H-C3 | Control group | 34.97 | 3.43 | 0.70 | 0.000 |
OSAS group | 39.08 | 5.60 | 1.14 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Tanellari, O.; Toti, C.; Baruti Papa, E.; Ghanim, S.; Savin, C.; Romanec, C.; Balcoș, C.; Zetu, I.N. The Link between Obstructive Sleep Apnea Syndrome and Cephalometric Assessment of Upper Airways and Hyoid Bone Position. Medicina 2022, 58, 1213. https://doi.org/10.3390/medicina58091213
Tanellari O, Toti C, Baruti Papa E, Ghanim S, Savin C, Romanec C, Balcoș C, Zetu IN. The Link between Obstructive Sleep Apnea Syndrome and Cephalometric Assessment of Upper Airways and Hyoid Bone Position. Medicina. 2022; 58(9):1213. https://doi.org/10.3390/medicina58091213
Chicago/Turabian StyleTanellari, Olja, Celjana Toti, Edlira Baruti Papa, Sara Ghanim, Carmen Savin, Cristian Romanec, Carina Balcoș, and Irina Nicoleta Zetu. 2022. "The Link between Obstructive Sleep Apnea Syndrome and Cephalometric Assessment of Upper Airways and Hyoid Bone Position" Medicina 58, no. 9: 1213. https://doi.org/10.3390/medicina58091213