Highlights
- •Upper airways in children with obstructive sleep apnea (OSA) are different from normal children.
- •There is need to identify potential craniofacial anatomy that may predispose to pediatric OSA.
- •There are cutoff values for cone-beam computed tomography measurements that may be predictive of the presence and severity of pediatric OSA.
ABSTRACT
Background
Morphometric evaluation of upper airways helps in identifying potential craniofacial
anatomy that may predispose to pediatric obstructive sleep apnea (OSA). This study
evaluated upper airway parameters three-dimensionally in children with OSA, with Class
II malocclusion and a retrognathic mandible, to identify cutoff values for cone-beam
computed tomography measurements that may predict the presence and severity of pediatric
OSA.
Methods
The study comprised 47 growing children with OSA with Class II malocclusion and 47
low-risk OSA-matched controls. Upper airway was segmented into nasopharynx, oropharynx,
and hypopharynx using cone-beam computed tomography and MIMICS16.0 software. Parameters
included volume, minimum cross-sectional area (CSAmin), anterioposterior and lateral distances of CSAmin, and upper airway length.
Results
The volume, cross-sectional area (CSAmin), and anteroposterior and lateral distances of CSAmin were significantly decreased at the level of the oropharynx in patients with OSA.
At the level of the hypopharynx, CSAmin was significantly narrower and upper airway length was significantly increased in
patients with OSA. OSA predictive cutoff values were proposed as 41.36 mm2 CSAmin at the level of oropharynx, 52.45 mm2 CSAmin at the level of hypopharynx, and 55.47 mm upper airway length. Only CSAmin at the level of the oropharynx had an independent association with OSA severity (P = 0.021).
Conclusions
Significant differences were found in the upper airway parameters of children with
OSA compared with corresponding controls. CSAmin may represent part of the issues that play a role in the pathogenesis of OSA and
may serve as a predictive of disease severity.
Keywords
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References
- Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents.Depress Anxiety. 2009; 26: 503-512
- Airway and systemic inflammation in obese children with asthma.Eur Respir J. 2013; 42: 1012-1019
- Different craniofacial characteristics predict upper airway collapsibility in Japanese-Brazilian and white men.Chest. 2016; 149: 737-746
- Correlation between craniofacial changes and respiratory improvement after nasomaxillary skeletal expansion in pediatric obstructive sleep apnea patients.Sleep Breath. 2022; 26: 585-594
- Airway volume for different dentofacial skeletal patterns.Am J Orthod Dentofacial Orthop. 2011; 139: e511-e521
- Evaluation of pharyngeal airway space amongst different skeletal patterns.Int J Oral Maxillofac Surg. 2012; 41: 814-819
- Childhood obstructive sleep apnea syndrome: an interdisciplinary approach.J Orofac Orthop. 2012; 73: 342-358
- Dental arch morphology in children with sleep-disordered breathing.Eur J Orthod. 2009; 31: 160-167
- Craniofacial morphology but not excess body fat is associated with risk of having sleep-disordered breathing—the PANIC Study (a questionnaire-based inquiry in 6–8-year-olds).Eur J Pediatr. 2012; 171: 1747-1752
- Three-dimensional cephalometric study of upper airway space in skeletal class II and III healthy patients.J Craniofac Surg. 2008; 19: 1497-1507
- The status of cephalometry in the prediction of non-CPAP treatment outcome in obstructive sleep apnea patients.Sleep Med Rev. 2016; 27: 56-73
- No correlation between two-dimensional measurements and three-dimensional configuration of the pharyngeal upper airway space in cone-beam computed tomography.J Craniomaxillofac Surg. 2017; 45: 371-376
- An analysis of different approaches to the assessment of upper airway morphology: a CBCT study.Orthod Craniofac Res. 2010; 13: 96-105
- Airway growth and development: a computerized 3-dimensional analysis.J Oral Maxillofac Surg. 2012; 70: 2174-2183
- Three-dimensional airway evaluation in 387 subjects from one university orthodontic clinic using cone beam computed tomography.Angle Orthod. 2012; 82: 985-992
- Compared to individuals with mild to moderate obstructive sleep apnea (OSA), individuals with severe OSA had higher BMI and respiratory-disturbance scores.Life (Basel). 2021; 11: 368-375
- Evaluation of upper airway in children with obstructive sleep apnea using cone-beam computed tomography.Laryngoscope. 2021; 131: 680-685
- Computational fluid dynamics simulation of the upper airway response to large incisor retraction in adult class I bimaxillary protrusion patients.Sci Rep. 2017; 7: 45706
- Establishment of reference mandibular plane for anterior alveolar morphology evaluation using cone beam computed tomography.J Zhejiang Univ Sci B. 2012; 13: 942-947
- Application of a newly developed software program for image quality assessment in cone-beam computed tomography.Imaging Sci Dent. 2017; 47: 75-86
- Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature.Int J Oral Maxillofac Surg. 2011; 40: 1227-1237
- Three-dimensional changes in upper airways of patients with obstructive sleep apnea following maxillomandibular advancement.J Oral Maxillofac Surg. 2007; 65: 6-12
- Airway changes in obstructive sleep apnoea patients associated with a supine versus an upright position examined using cone beam computed tomography.J Laryngol Otol. 2014; 128: 824-830
- Pharyngeal airway dimensions and head posture in obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine.J Oral Maxillofac Res. 2017; 8: e4
- Current methods in medical image segmentation.Annu Rev Biomed Eng. 2000; 2: 315-337
- Assessment of the airway in obstructive sleep apnea syndrome with 3-dimensional airway computed tomography.Otolaryngol Head Neck Surg. 2000; 123: 444-449
- Oropharyngeal airway changes after rapid palatal expansion evaluated with cone-beam computed tomography.Am J Orthod Dentofacial Orthop. 2010; 137 (Suppl.): S71-S78
- Creation of an idealized nasopharynx geometry for accurate computational fluid dynamics simulations of nasal airflow in patient-specific models lacking the nasopharynx anatomy.Int J Numer Method Biomed Eng. 2017;
- Cone-beam CT analysis of patients with obstructive sleep apnea compared to normal controls.Imaging Sci Dent. 2016; 46: 9-16
- Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls.Am J Respir Crit Care Med. 1995; 152: 1673-1689
- Magnetic resonance imaging of the pharynx in OSA patients and healthy subjects.Eur Respir J. 2001; 17: 79-86
- Evaluation of cross-section airway configuration of obstructive sleep apnea.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: 102-108
- Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review.Sleep Med. 2016; 21: 19-27
- Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea.J Oral Maxillofac Surg. 2010; 68: 354-362
- Upper airway length may be associated with the severity of obstructive sleep apnea syndrome.Sleep Breath. 2008; 12: 311-316
- Cone beam computed tomography analysis of upper airway measurements in patients with obstructive sleep apnea.Am J Med Sci. 2016; 352: 376-384
- Relating three-dimensional airway measurements to the apnea hypopnea index in pediatric sleep apnea patients.Orthod Craniofac Res. 2021; 24: 137-146
- Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea.J Oral Maxillofac Surg. 2010; 68: 2846-2855
- Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and control subjects.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 285-293
Article info
Publication history
Published online: September 23, 2022
Accepted:
August 9,
2022
Received in revised form:
August 7,
2022
Received:
June 6,
2022
Footnotes
Funding: This work was supported by Health Campus in Universiti Sains Malaysia under the RUI grant scheme 1001/PPSG/812158.
Competing interests: Authors have completed and submitted the ICMJE Form for Disclosure of potential conflicts of interest. None declared.
Provenance and peer review: Non-commissioned; externally peer reviewed.
Identification
Copyright
© 2022 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.
