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Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

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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.

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References

  1. Brouillette RT, Fernbach SK, Hunt CE (1982) Obstructive sleep apnea in infants and children. J Pediatr 100:31–40

    CAS  PubMed  Google Scholar 

  2. Lipton AJ, Gozal D (2003). Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev 7:61–80

    Article  PubMed  Google Scholar 

  3. Marcus CL (2001) Sleep-disordered breathing in children. Am J Respir Crit Care Med 164:16–30

    CAS  PubMed  Google Scholar 

  4. 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

    CAS  PubMed  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. 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

    CAS  PubMed  Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. Jamieson A, Guilleminault C, Partinen M, et al (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 9:469–477

    CAS  PubMed  Google Scholar 

  9. Strelzow VV, Blank RH, Basile A, et al (1988) Cephalometric airway analysis in sleep related breathing disorders. Laryngoscope 98:1149–1158

    CAS  PubMed  Google Scholar 

  10. DeBerry-Borowiecki B, Kukwa AA, Blanks RH (1988) Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 98:226–234

    CAS  PubMed  Google Scholar 

  11. Bacon WH, Krieger J, Turlot JC, et al (1988) Craniofacial characteristics in patients with sleep apneas syndrome. Cleft Palate J 25:374–378

    CAS  PubMed  Google Scholar 

  12. Maltais F, Series F, Carrier G, et al (1991) Cephalometric measurements in snorers, non-snorers and sleep-apnea patients. Thorax 46:419–423

    CAS  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

  15. 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

    CAS  PubMed  Google Scholar 

  16. Isono S, Remmers JE, Tanaka A, et al (1996) Static properties of the passive pharynx in sleep apnea. Sleep 19:175–177

    Google Scholar 

  17. 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

    CAS  PubMed  Google Scholar 

  18. Croft CB, Pringle M (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnea. Clin Otolaryngol 16:504–509

    CAS  PubMed  Google Scholar 

  19. 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

  20. Nelson S, Hans M (1997) Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 111:154–162

    CAS  PubMed  Google Scholar 

  21. Engman LT, Spriestersbach DC, Moll KL (1965) Cranial base angle and nasopharyngeal depth. Cleft Palate J 45:32–39

    CAS  PubMed  Google Scholar 

  22. Harris EF (1993) Size and form of the cranial base in isolated cleft lip and palate. Cleft Palate Craniofac J 30:170–174

    CAS  PubMed  Google Scholar 

  23. 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

    CAS  PubMed  Google Scholar 

  24. 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

    CAS  PubMed  Google Scholar 

  25. 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

    CAS  PubMed  Google Scholar 

  26. Kuna S, Remmers JE (1985) Neural and anatomic factors related to upper airway occlusion during sleep. Med Clin North Am 69:1221–1242

    CAS  PubMed  Google Scholar 

  27. 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

    CAS  PubMed  Google Scholar 

  28. Jain A, Sahni JK (2002) Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy. J Laryngol Otol 116:711–715

    Article  PubMed  Google Scholar 

  29. Grundfast KM, Wittich DJ Jr (1982) Adenotonsillar hypertrophy and upper airway obstruction in evolutionary perspective. Laryngoscope 92:650–656

    CAS  PubMed  Google Scholar 

  30. Shintani T, Asakura K, Kataura A (1998) The effect of adenotonsillectomy in children with OSAS. Int J Pediatr Otorhinolaryngol 44:51–58

    Article  CAS  PubMed  Google Scholar 

  31. 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

    CAS  PubMed  Google Scholar 

  32. Tomer BS, Harvold EP (1982) Primate experiments on mandibular growth direction. Am J Orthod 82:114–119

    CAS  PubMed  Google Scholar 

  33. Guilleminault C, Partinen M, Praud JP, et al (1989) Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr 114:997–999

    CAS  PubMed  Google Scholar 

Download references

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Correspondence to Hüseyin Özdemir.

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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

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  • DOI: https://doi.org/10.1007/s00247-004-1168-x

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