Abstract
Background
Cephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS).
Objective
To evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity.
Materials and methods
The study population consisted of 39 children, aged 4–12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded.
Results
Cranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P<0.001). Protrusion of the maxilla (SNA) and mandible (SNB) did not correlate with AHI scores (P>0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=−0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH (P<0.001).
Conclusions
There is significant correlation between cephalometric data and AHI score severity in children with OSAS. Adenotonsillar hypertrophy affects the cephalometric measurements adversely. The study clearly mandates the institution of early and effective therapy of adenotonsillar hypertrophy in children with OSAS.
Similar content being viewed by others
References
Brouillette RT, Fernbach SK, Hunt CE (1982) Obstructive sleep apnea in infants and children. J Pediatr 100:31–40
Lipton AJ, Gozal D (2003). Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev 7:61–80
Marcus CL (2001) Sleep-disordered breathing in children. Am J Respir Crit Care Med 164:16–30
Finkelstein Y, Wexler D, Berger G, et al (2000) Anatomical basis of sleep-related breathing abnormalities in children with nasal obstruction. Arch Otolaryngol Head Neck Surg 126:593–600
Miyao E, Miyao M, Ohta T, et al (2000) Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms. Psychiatry Clin Neurosci 54:659–664
Marcus CL, McColley SA, Carroll JL, et al (1994) Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Physiol 77:918–924
Paoli JR, Lauwers F, Lacassagne L, et al (2001) craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: cephalometric study in 85 patients. Br J Oral Maxillofac Surg 39: 40–45
Jamieson A, Guilleminault C, Partinen M, et al (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 9:469–477
Strelzow VV, Blank RH, Basile A, et al (1988) Cephalometric airway analysis in sleep related breathing disorders. Laryngoscope 98:1149–1158
DeBerry-Borowiecki B, Kukwa AA, Blanks RH (1988) Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 98:226–234
Bacon WH, Krieger J, Turlot JC, et al (1988) Craniofacial characteristics in patients with sleep apneas syndrome. Cleft Palate J 25:374–378
Maltais F, Series F, Carrier G, et al (1991) Cephalometric measurements in snorers, non-snorers and sleep-apnea patients. Thorax 46:419–423
Greenfeld M, Tauman R, DeRowe A, et al (2003) Sleep related breathing disorders due to adenotonsillar hypertrophy in infants. Int J Pediatr Otorhinolaryngol 67:1055–1060
Schechter MS; Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome (2002) Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 109:e69
Bacon WH, Turlot JC, Krieger J, et al (1990) Cephalometric evaluation of pharyngeal obstructive factors in patients with sleep apneas syndrome. Angle Orthod 60:115–122
Isono S, Remmers JE, Tanaka A, et al (1996) Static properties of the passive pharynx in sleep apnea. Sleep 19:175–177
Ellis PD, Williams JE, Shneerson JM (1993) Surgical relief of snoring due to palatal flutter: a preliminary report. Ann R Coll Surg Engl 75:286–290
Croft CB, Pringle M (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnea. Clin Otolaryngol 16:504–509
Lugaresi E, Cirignotta F, Montagna P (1989) Snoring: pathogenesis, clinical and therapeutic aspects. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine. Saunders, Philadelphia, pp 494–500
Nelson S, Hans M (1997) Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 111:154–162
Engman LT, Spriestersbach DC, Moll KL (1965) Cranial base angle and nasopharyngeal depth. Cleft Palate J 45:32–39
Harris EF (1993) Size and form of the cranial base in isolated cleft lip and palate. Cleft Palate Craniofac J 30:170–174
Zucconi M, Strambi L, Ferini SP, et al (1993) Craniofacial cephalometric evaluation in habitual snorers with and without obstructive sleep apnoea. Otolaryngol Head Neck Surg 109:1007–1013
Hochban W, Brandenburg U (1994) Morphology of the viscerocranium in obstructive sleep apnoea syndrome: cephalometric evaluation of 400 patients. J Craniomaxillofac Surg 22:205–213
Miles PG, Vig PS, Weyant RJ, et al (1996) Craniofacial structure and obstructive sleep apnoea syndrome: a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop 109:163–172
Kuna S, Remmers JE (1985) Neural and anatomic factors related to upper airway occlusion during sleep. Med Clin North Am 69:1221–1242
Brown IG, Bradley TD, Phillipson EA, et al (1985) Pharyngeal compliance in snoring subjects with and without obstructive sleep apnea. Am Rev Respir Dis 132:211–215
Jain A, Sahni JK (2002) Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy. J Laryngol Otol 116:711–715
Grundfast KM, Wittich DJ Jr (1982) Adenotonsillar hypertrophy and upper airway obstruction in evolutionary perspective. Laryngoscope 92:650–656
Shintani T, Asakura K, Kataura A (1998) The effect of adenotonsillectomy in children with OSAS. Int J Pediatr Otorhinolaryngol 44:51–58
Woodside DG, Linder-Aronson S, Lundstrom A, et al (1991) Mandibular and maxillary growth after change mode of breathing. Am J Orthod Dentofacial Orthop 100:1-18
Tomer BS, Harvold EP (1982) Primate experiments on mandibular growth direction. Am J Orthod 82:114–119
Guilleminault C, Partinen M, Praud JP, et al (1989) Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr 114:997–999
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Özdemir, H., Altin, R., Söğüt, A. et al. Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients. Pediatr Radiol 34, 393–399 (2004). https://doi.org/10.1007/s00247-004-1168-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-004-1168-x