Cephalometric,muscular and swallowing changes in patients with OSAS

Obstructive Sleep Apnoea Syndrome (OSAS) is believed to be associated with craniofacial and neuromuscular changes, although the interplay among these variables still is poorly recognised. The objective of this study was to identify hyoid, muscular and swallowing changes associated with OSAS, and to correlate these alterations with OSAS severity. Cross‐sectional study, in a tertiary referral centre. Seventy‐two adult individuals participated in this study: 12 controls (without apnoea) and 60 patients with apnoea (mild, moderate and severe OSAS—20 individuals in each group). All participants were initially evaluated by otorhinolaryngologist and neurologist and underwent polysomnography for OSAS stratification. Cephalometric data, clinical myofunctional status and swallow videofluoroscopy exam were assessed. A hybrid effect model was used to analyse swallowing parameters; dependent variables were age, body mass index (BMI) and cephalometric measures. Individuals with OSAS presented lower hyoid position and narrower posterior airway distance when compared to controls. These parameters correlated to OSAS severity. Additionally, OSAS patients exhibited significantly lower myofunctional scores. Both velum and hyoid contraction times were significantly lower in the OSAS group at videofluoroscopy, regardless of its severity. Premature leakage into pharynx was more common in OSAS groups. Laryngeal penetration phenomenon occurred only in two patients (both from OSAS group). Our results suggest that hyoid bone position is associated with OSAS severity. Muscular pattern and swallowing are impaired in OSAS patients, irrespective of OSAS severity and facial profile. These findings indicate a higher predisposition of OSAS patients to present an inferior hyoid positioning, accompanied by myofunctional and swallowing disorders.     

OSAS患者的颅面上气道结构的矢状面测量分析

目的:研究OSAS患者的颅面上气道形态异常,探讨OSAS患者的结构性致病因素。方法:31名男性OSAS患者与16名无自觉症状的男性组成的对照组进行颅面结构上气道的头影测量比较。结果:与对照组相比,OSAS患者存在ANB角大,颌凸角大,具有安氏II类骨型的趋势。表现出舌骨位置靠前,舌体长大,骨性鼻咽高度降低,软腭后间隙窄。结论:OSAS患者颅面形态倾向于安氏II类骨型,气道狭窄处在鼻咽、腭咽,说明结构性致病因素不容忽视。     

男性儿童 OSAS上气道及周围结构X线头影测量研究

目的本文旨在对儿童阻塞性睡眠呼吸暂停综合征(简称OSAS)患者的上气道及其周围结构进行X线头影测量研究。方法运用计算机辅助X线头影测量技术,对7例替牙期男性儿童OSAS进行了颅、面、颌、咽部形态特征研究,并与正常儿童作比较。结果替牙期男性OSAS患者颅底长度、腭平面角和下颌平面角均增大,舌体高度增加,舌骨位置下降,舌根和软腭后气道前后径减小,软腭与舌体占整个口咽腔的比例增大。结论儿童OSAS患者的颅、面、颌、咽部结构存在有别于正常儿童的异常特征。X线头影测量是一种简便而实用的评估OSAS的方法,有助于临床诊断和治疗计划的制定。     

Dentofacial characteristics of Chinese obstructive sleep apnea patients in relation to obesity and severity

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.     

口腔矫治器治疗阻塞性睡眠呼吸暂停综合征的疗效分析

目的借助Ｘ线头影测量预测ＯＳＡＳ患者颅面形态与其口腔矫治器治疗效果的关系。方法２２例矫治器治疗的ＯＳＡＳ患者，将治疗前后多导睡眠监测所得的呼吸功能改变与治疗前Ｘ线头影测量值进行相关分析；同时根据患者疗效分组，比较不同疗效组颅面形态的差异。结果ＯＳＡＳ患者呼吸暂停指数的改善主要与颅面硬组织的形态有显著相关性；最低血氧饱和度的改善仅与下颌体长度及舌根部前后位置显著相关；而呼吸紊乱指数的改变与形态变量无显著相关性；不同疗效组间颅面结构存在明显差异，Ⅱ类高角特征越明显者，疗效越差。结论口腔矫治器治疗ＯＳＡＳ的疗效主要与颅面硬组织的形态有关，而与上气道的大小无显著相关性。     

Obstructive sleep apnea: a principal component analysis

A principal component analysis was performed on the cephalometric variables of 100 male obstructive sleep apnea (OSA) patients. Thirty cephalometric variables of cervicocraniofacial skeletal morphology were reduced to 8 principal components (PCs), which described 83.2% of the total variance. Sixteen cephalometric variables of hyoid bone position and head posture were reduced to 4 PCs, which described 85.5% of the total variance. Twenty cephalometric variables of upper airway soft tissue were reduced to 7 PCs, which described 83.7% of the total variance. These PCs described the actual characteristics of the OSA patients examined. For further analysis of PCs, stepwise multiple regression analysis was chosen. Two dependent variables of interest are the minimal distance of posterior pharyngeal airway space (PASmin) and the Apnea-Hypopnea Index (AHI). Seven PCs accounted for 79.4% of the variance of PASmin and 3 PCs accounted for 37.6% of the variance of AHI. Both principal component analysis and multiple regression analysis provide multivariate data analysis that is very useful in sorting out and clarifying the complexity of the interrelated cervicocraniofacial skeletal morphology and upper airway soft tissue in OSA patients.     

The curve of Spee and craniofacial morphology: a multiple regression analysis

The aim of this study was to investigate the relationship between the curve of Spee and skeletal facial morphology. Dental casts and lateral cephalograms were obtained from 59 orthodontic patients. The amount of concavity of the curve of Spee was calculated by a second-order quadratic interpolation of buccal cusp tips obtained from lateral digital photographs of the teeth. The cephalometric analysis aimed to evaluate the sagittal and vertical craniofacial dimensions as well as the position of the mandibular condyle with respect to the occlusal plane. These variables, included in a multiple regression model, could explain 34% of the total variance of the curve of Spee. The amount of the curvature was significantly related to (a) the horizontal position of the condyle with respect to the dentition, (b) the sagittal position of the mandible with respect to the anterior cranial base, and (c) the ratio between the posterior and anterior facial height. No significant relationship was found between the curve of Spec and any of the other cephalometric variables. The curve of Spee was not influenced by age and gender of the subjects investigated.     

Sex-dependent differences in the craniofacial morphology of children with a sleep-related breathing disorder

OBJECTIVE: The purpose of this article was to compare the craniofacial morphology and hyoid bone position of preschool girls and boys with sleep-related breathing disorder (SBD). STUDY DESIGN: The control groups consisted of girls and boys without ear, nose, and throat disorders. After lateral cephalometric radiographs were taken, the children were selected on the basis of the head position in relation to the true horizontal. Thirty-eight cephalometric variables were determined. RESULTS The findings indicate that boys with SBD had a larger anterior lower facial height and a more anterior hyoid bone position than girls with SBD. However, the distance between the third cervical vertebra and the hyoid bone was a constant value among girls and boys with SBD. Girls with SBD had a sagittally narrower pharyngeal airway space than boys with SBD. CONCLUSION: These findings suggest that boys with SBD have a skeletal risk factor, whereas girls with SBD have an airway risk factor. In conclusion, the difference in risk factors may have some bearing on the greater incidence of SBD in both boys and men.     

Associations among upper airway structure, body position, and obesity in skeletal Class I male patients with obstructive sleep apnea

Interactions between upper airway structure and posture in relation to obesity were studied in a sample of 61 adult Class I skeletal type male patients with obstructive sleep apnea (OSA) and 10 homologous control subjects. A pair of upright and supine lateral cephalometric films were taken for each subject. A Pearson correlation analysis identified significant r values for several demographic variables in patients with OSA such as apnea and hypopnea index, percentage of predicted neck circumference, minimum arterial oxygen saturation, and body mass index (BMI). The difference between cephalometric variables identified in upright and supine subjects was calculated. When patients with OSA changed their posture from upright to supine, significant correlations were observed between the cranial base to upper cervical column angle and the hypopharynx cross-sectional area and BMI. Moreover, the mandibular plane angle and the sella-nasion plane was significantly correlated with BMI. This occurred along with a significant positive correlation between the sella-nasion plane angle and BMI and a significant inverse correlation between the mandibular plane angle in reference to the absolute vertical and horizontal planes, with BMI after the positional change. Such correlations were not observed in control subjects. No correlations were observed between the variables related to the position of the hyoid bone with BMI in either patients with OSA or control subjects after the change in posture. On the basis of these findings, we propose that when patients with OSA change their body position from upright to supine (1) the patient's neck is more extended, and (2) the hyoid bone moves more anterosuperiorly in conjunction with an upward and forward rotation of the mandible. This change in craniofacial structure may be a compensatory geometrical change in the upper airway to secure its patency. (Am J Orthod Dentofac Orthop 1996;109:625-34.)     

Cephalometric analysis of the obstructive sleep apnea syndrome

The cephalometric measurements of 33 Finnish OSAS patients showed a fairly normal relationship between the base of the skull and the maxilla (SNA 82.3), whereas the mandible was slightly smaller than average (SNB 78.0). In 58% of the patients the mandible was significantly retrognathic and/or small in relation to the maxilla, even if dental occlusion was satisfactory. The sagittal lengths of the anterior cranial base and the maxilla were fairly normal. The hyoid bone was constantly situated more inferiorly and posteriorly than on average (MP-H 32.6). UPPP, genioplasty and advancement of the floor of the mouth and hyoid suspension were found to be effective in severe OSAS. The changes caused by the operation could best be verified cephalometrically by a more anterior position of the hyoid bone (average change of 11.1 mm).     

济南地区儿童上气道及舌骨位置正常参考值的研究

目的建立济南市11～13岁儿童上气道大小及舌骨位置的正常参考值范围。方法选择无阻塞性睡眠呼吸暂停综合征临床症状的儿童208名,男性71名,女性137名,年龄11～13岁,拍摄X线数字头颅侧位片,测量其骨面型、上气道形态及舌骨位置,使用SPSS 13.0软件对测量值进行统计学分析,建立上气道及舌骨正常参考值范围。结果恒牙列初期儿童上气道大小和舌骨位置存在性别差异,女性上气道SPP-SPPW平面的矢状径比男性大（P〈0.05）;女性软腭中后气道间隙较男性大;男性比女性的舌骨位置低且靠前。结论建立了济南市恒牙初期儿童上气道及舌骨位置的正常参考值范围。     

下颌前移矫正器治疗阻塞性睡眠呼吸暂停综合征患者的疗效分析

目的　分析下颌前移矫正器治疗阻塞性睡眠呼吸暂停综合征 (OSAS)的临床疗效及与颅面结构、上气道的关系。方法　对 4 0例轻、中度OSAS患者进行治疗前X线头影测量 ,睡眠时戴用下颌前移矫正器治疗 ,用多导睡眠图监测评价疗效 ,并与颅面结构、上气道各指标进行相关分析。结果　下颌前移矫正器治疗OSAS患者的客观有效率为 88.6 %。治疗前、后睡眠呼吸暂停的通气指数 (AHI)减少百分比 (△AHI)与颅面结构中的SNB角 (r =- 0 4 97) ,ANB角 (r=0 .5 36 )及下颌平面角MP -FH(r=- 0 2 5 2 )相关 ,亦与舌骨高度H -MP(r=- 0 35 1)及软腭的长度SPL(r=- 0 36 6 )相关。结论　下颌前移矫正器通过前移下颌间接扩大上气道达到治疗效果     

Relationship of the functional oropharynx to craniofacial morphology.

The association between the functional oropharyngeal airway (defined as the minimal sagittal dimension at right angles to the airstream) and craniofacial morphology was investigated using 16 craniofacial variables taken from lateral cephalometric radiographs. The sample consisted of 70 subjects (31 males and 39 females) 10 to 13 years of age. There was no difference in ages between males and females, and no correlation with age except upper face height. Oropharyngeal airway was positively correlated with length of the mandible (Gon-Men), the distance between the third cervical vertebra and the hyoid bone (C3-Hy), and cranial base angle (NSBa). Although short mandibular length is a characteristic finding in patients with obstructive sleep apnea, none of the subjects in this study had this diagnosis.     

Cephalometric analysis of nonobese snorers either with or without obstructive sleep apnea syndrome

OBJECTIVE: To determine if there is an indicator on the lateral cephalometric radiograph that can be used for the differential diagnosis of severe obstruct sleep apnea syndrome and simple snoring in nonobese young male adults. MATERIALS AND METHODS: The subjects were Taiwanese male patients with a complaint of snoring and/or sleep apnea, whose body mass index was less than 25 kg/m(2) and who were younger than 40 years old. Forty-six patients with severe obstructive sleep apnea and 36 patients with simple snoring were selected and underwent lateral cephalometric radiography, from which 24 linear and 34 angular measurements were calculated. Differences between the two groups were studied, and a discriminatory analysis was performed. RESULTS: Soft palate length, mandibular body length, tongue size, and distance from the hyoid bone to the mandibular plane were significantly larger in patients with severe obstructive sleep apnea syndrome. Of the original grouped cases, 76.5% were correctly classified using these five variables. The position of the hyoid bone in simple snorers was near the straight line from the third vertebra to the menton, whereas the position of the hyoid bone in severe obstruct sleep apnea syndrome patients was far below the line from the third vertebra to the menton. CONCLUSION: The position of the hyoid bone relative to the line from the third vertebra to the menton can be used as an indicator for a diagnosis of severe obstruct sleep apnea syndrome in nonobese young male Taiwanese adults.     

Alterations of hyoid bone position and pharyngeal depth and their relationship after surgical correction of mandibular prognathism

The present investigation studied changes of hyoid bone position and pharyngeal depth at the levels of the second and fourth cervical vertebrae and their relationships in mandibular prognathism patients who received combined orthodontic-surgical treatment. The material consisted of presurgical and 1-year postsurgical profile cephalograms of 52 adult orthognathic surgery patients (40 females and 12 males) who initially had mandibular prognathism and had undergone bilateral vertical ramus osteotomy through an extraoral incision in the retroangular area. Hyoid bone position and pharyngeal depth were assessed on the profile radiographs with 10 cephalometric variables. Paired t tests were used to evaluate the operative changes in all cephalometric parameters. The relationships between pairs of variables describing hyoid bone position and pharyngeal depth were assessed by means of Pearson's product-moment correlation analysis. Significant differences (p less than 0.01) were observed for the distances of the hyoid bone to the maxilla and the mandible. The distances of the hyoid bone with the anterior cranial base, the vertebral column, and the anterior pharyngeal wall, and the measurements representing pharyngeal depth exhibited no significant changes (p greater than 0.05). Moderate correlations were seen between (1) the depth of the pharynx at the fourth cervical vertebra and the hyosymphyseal distance (r = 0.34) and the distance between the point of the projection of the hyoid bone to the mandibular line with its posterior border (r = -0.34), and (2) the depth of the pharynx at the second cervical vertebra and the distance of the hyoid bone with the anterior pharyngeal wall at the level of the fourth cervical vertebra (r = -0.33).(ABSTRACT TRUNCATED AT 250 WORDS)     

Craniofacial skeletal architecture and obstructive sleep apnoea syndrome severity

Obstructive sleep apnoea syndrome (OSAS) is a sleep related breathing disorder caused by pharynx obstruction that often terminates in abrupt arousals and is capable of disrupting physiological sleep profile. Its' severity has been associated, among others, with craniofacial skeletal morphology. To investigate this relationship and elucidate craniofacial skeleton patterns in individuals without obvious maxillofacial abnormalities, 171 OSAS patients were studied with nocturnal polysomnographic record and chephalometric X-ray (24 variables). Chephalometric variables were compared between three apnoea/hypopnoea index (AHI) groups (AHI ≤ 15; 15 < AHI < 30; AHI ≥ 30) and uni/multivariate analysis between chephalometric variables and AHI were performed.The patients were predominantly men (83%), with a mean age of 48.1 years. Mean BMI and AHI were 28.4 kg/m² and 26.2, respectively. Most chephalometric variables differed among the three AHI groups. Fifteen chephalometric variables showed a correlation with AHI. Five chephalometric variables and BMI were independent AHI predictors. Chephalometric variables were better AHI predictors in normal weight patients.Significant evidence of craniofacial skeleton influence was found on OSAS severity, caudalization of the hyoid and lower sagittal facial projection being the most important patterns. From the chephalometric variables analysed, the hypopharynx calibre demonstrated a higher predictive value for AHI, independently of BMI.     

Obstructive sleep apnea: a canonical correlation of cephalometric and selected demographic variables in obese and nonobese patients

One hundred male obstructive sleep apnea (OSA) patients were classified into 2 groups on the basis of body mass index (BMI): 43 nonobese (BMI < 30 kg/m2) and 57 obese (BMI > or = 30 kg/m2) patients. A comprehensive cephalometric analysis with a multivariate statistical method was performed in order to define the different principal components (PCs) of cervico-craniofacial skeletal and upper airway soft tissue morphology in each group and how they contributed to selected elements of the patient demographic data, ie, apnea-hypopnea index (AHI), nocturnal oxyhemoglobin saturation, and BMI. Thirty cephalometric variables of cervico-craniofacial skeletal morphology were reduced to 8 PCs describing 84.4% and 85.4% of the total variance in obese and nonobese OSA patients, respectively. Sixteen cephalometric variables of hyoid bone position and head posture were reduced to 4 PCs describing 84.4% and 85.9% of the total variance in obese and nonobese OSA patients, respectively. Twenty cephalometric variables of upper airway soft tissue morphology were reduced to 7 PCs describing 89.5% and 84.6% of the total variance in obese and nonobese OSA patients, respectively. For further analysis of PCs, a stepwise multiple regression analysis was chosen. Two dependent variables of interest are the minimal distance of the posterior pharyngeal airway space (PASmin) and AHI. PASmin accounted for 95.3% (obese OSA group) and 74.3% (nonobese OSA group) with 7 PCs and AHI for 46% with 3 PCs in both groups. Three canonical variables and their correspondents with different loadings were established differently for both OSA groups. A canonical correlation successfully clarified the complexity of simultaneous relationship of the relevant variables. These analyses are proved useful to demonstrate the relationship of cervico-craniofacial skeletal and upper airway soft tissue morphology and selected demographic data. This lays down a basis for understanding the complicated pathogenic components of obese and nonobese OSA patients.     

Estrogen receptor gene polymorphism and craniofacial morphology in female TMJ osteoarthritis patients

The aim of this study was to investigate the possible influence of estrogen receptor alpha (ERalpha) polymorphism on the craniofacial skeleton in female patients suffering from symptomatic osteoarthritis (OA) of the temporomandibular joint (TMJ). The sample comprised 76 genetically unrelated Korean women diagnosed with OA by research diagnostic criteria for temporomandibular disorders (RDC-TMD). Direct haplotyping procedure was used to analyze the PvuII and XbaI RFLPs. Twelve cephalometric measurements were taken to evaluate the spatial position and dimensions of the mandible. Mann-Whitney's U-test was used to identify the potential differences in the cephalometric measurements between the subjects grouped according to their carrier status for Px haplotype. In addition, an association study was carried out using chi(2)-test to further examine the relationship between Px haplotype and the craniofacial morphology of the symptomatic OA patients. Female symptomatic TMJ OA patients carrying Px haplotype showed significantly smaller facial axis angle (P<0.05) and mandibular body length (P<0.05) than the non-carriers. The association between the presence of Px haplotype and short mandibular body length was also ascertained. This study suggests that ERa polymorphism contributes to the altered mandibular dimensions in female symptomatic TMJ OA patients. Further studies on the role of the genetic markers relevant to the craniofacial growth and adaptation are expected to broaden our understanding of determinants of the craniofacial morphology.     

Craniofacial morphology of Malay patients with obstructive sleep apnoea

The aim of this study was to compare the skeletal and soft tissue patterns between obstructive sleep apnoea (OSA) patients and control group of non-OSA patients. Fifty Malays (32 males and 18 females) aged 18-65 years divided into two equal groups 25 (17 males and 8 females) with OSA and a control group 25 subjects (15 males and 10 females). Both groups were diagnosed using polysomnography. Nineteen variables related to craniofacial skeletal and soft tissue morphology were measured on lateral cephalometric films. Analysis of covariance was used to compare the means between the two groups. The results showed that OSA subjects had a significant increase in body mass index (BMI) and neck circumference than the control group. The soft palate and tongue were longer and thicker in OSA patients. In addition, upper, middle, and lower posterior airway spaces were narrower, the hyoid bone was more inferior and posterior, and the cranial base flexure angle was significantly acute when compared with the control group. The findings indicate that craniofacial abnormalities play significant roles in the pathogenesis of OSA in Malay patients.     

颞下颌关节强直患者的X线头影测量分析

目的：随着颞下颌关节强直发病年龄和病程的不同，其对颅颌面软硬组织发育造成的影响也不同。该研究旨在明确各年龄组患者头影测量特征和发病年龄，病程对颅颌面软组织的影响。方法４６例男性颞下颌关节强直患者和相应年龄的正常对照者进行头影测量分析，按发病年龄，病程分组以ＳＰＳＳＷＩＮ统计软件进行统计分析。结果各组患者与相应对照组正常人相比颌骨向后上方向缩进，舌骨朝后下方向移位，中下咽腔明显狭窄，；患者舌和软腭占