Cephalometric assessment of craniofacial morphology in Japanese male patients with obstructive sleep apnea-hypopnea syndrome

Abstract

CRANIOFACIAL MORPHOLOGICAL ANOMALIES CAN BE DIVIDED INTO TWO PRINCIPAL CATEGORIES: skeletal anomalies and soft tissue anomalies. This study examined the hypothesis that the assessment of indices representing both skeletal and soft tissue can be used to appropriately identify the risk factor of obstructive sleep apnea-hypopnea syndrome (OSAHS). 232 suspected OSAHS male patients were examined with polysomnography and divided into two groups (202 males with OSAHS and 30 male controls without OSAHS). Cephalometric analysis was performed on all patients to evaluate craniofacial morphological anomalies. The measurement sites were as follows: skeletal morphology; soft tissue morphology; mixed morphology including mandibular plane to hyoid bone (MP-H); and jaw soft tissue (JS) ratio; a novel ratio we defined, between the area of jaw and area of tongue with soft palate. JS ratio increased with AHI as well as MP-H. MP-H and JS ratio showed significant but weak correlation with apnea-hypopnea index. JS ratio was significantly associated with an increased risk for severe OSAHS, even after adjusting age and BMI, its odds ratio was the greatest among these variables. These results showed that mixed craniofacial, skeletal and soft tissue morphology are correlated with AHI, and JS ratio may be a useful parameters to explain the characteristics of OSAHS in male patients.

Figure 1

Cephalometric point of skeletal, soft tissue and mixed morphology. ANS, anterior nasal spine; Ba, basion; FP, facial plane; Gn, gnathion; Go, gonion; H, hyoid; Me, menton; MP, mandibular plane; MP-H, mandibular plane – hyoid; N, nasion; PNS, posterior nasal spine; Pog, pogonion; PP, palatal plane; Pt, pterygoid point. The following angles in degrees and dimensions in millimeters were measured: FX: facial axis. The following cross-sectional areas are in cm²: soft palate area: outlined by the soft palate surface; tongue area: outlined by the dorsum of the tongue surface and lines that connect tongue tip, spina mentalis, hyoid, and base of epiglottis; jaw area: under the PP and outlined lines that connect ANS, subspinale, prosthion, infradentale, supramentale, Pog, Me and Go.