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. 2024 Jun 17;13(12):3540.
doi: 10.3390/jcm13123540.

Relationship between Cephalometric and Ultrasonic Airway Parameters in Adults with High Risk of Obstructive Sleep Apnea

Anutta Terawatpothong  1 , Chidchanok Sessirisombat  1 , Wish Banhiran  2 , Hitoshi Hotokezaka  3 , Noriaki Yoshida  3 , Irin Sirisoontorn  1
Affiliations

Relationship between Cephalometric and Ultrasonic Airway Parameters in Adults with High Risk of Obstructive Sleep Apnea

Anutta Terawatpothong et al. J Clin Med. .

Abstract

Background/Objectives: Polysomnography and cephalometry have been used for studying obstructive sleep apnea (OSA) etiology. The association between craniofacial skeleton and OSA severity remains controversial. To study OSA's etiology, cephalometry, fiberoptic pharyngoscopy, polysomnography, and sleep endoscopy have been used; however, airway obstructions cannot be located. Recent research suggested ultrasonography for OSA screening and upper airway obstruction localization. Thus, this study aims to investigate the relationship between specific craniofacial cephalometric and ultrasonic airway parameters in adults at high risk of OSA. Methods: To assess craniofacial structure, lateral cephalograms were taken from thirty-three adults over 18 with a STOP-Bang questionnaire score of three or higher and a waist-to-height ratio (WHtR) of 0.5 or higher. Airway parameters were assessed through submental ultrasound. Results: NSBA correlated with tongue base airspace width, while MP-H correlated with oropharynx, tongue base, and epiglottis airspace width. SNA, SNB, and NSBA correlated with tongue width at the oropharynx. At tongue base, ANB and MP-H correlated with tongue width. SNB and NSBA were associated with deep tissue thickness at the oropharynx, while MP-H correlated with superficial tissue thickness at velum and oropharynx. Conclusions: Cephalometric parameters (SNA, SNB, ANB, NSBA, and MP-H) were correlated with ultrasonic parameters in the velum, oropharynx, tongue base, and epiglottis.

Keywords: lateral cephalometry; obstructive sleep apnea; ultrasonography.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow diagram. Subjects were considered high-risk if STOP-Bang scores were ≥3 according to the version used in the Department of Otorhinolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand [12].
Figure 2
Figure 2
STOP-Bang questionnaire, BMI cutoff point was >30 kg/m2 adjusted for Thais [12].
Figure 3
Figure 3
Cephalometric landmarks and parameters. Landmarks: S, sella; N, nasion; Ba, basion; A, subspinale; B, supramental; Go, Gonion; Gn, Gnathion; MP, mandibular plane; P, tip of soft palate; H, hyoid; PNS, posterior nasal spine; PAS, posterior airway space. Parameters: SNA (degree), antero-posterior position of the maxilla relative to the anterior cranial base; SNB (degree), antero-posterior position of the mandible relative to the anterior cranial base; ANB (degree), the difference between SNA and SNB; NSBA (degree), angle formed by nasion–sella–basion; MP-H (mm), perpendicular distance from hyoid bone to mandibular plane (vertical position of hyoid bone); PAS (mm), retroglossal posterior airway space, defined as the shortest distance between base of tongue and posterior pharyngeal wall; PNS-P (mm), soft palate length, measured from the posterior nasal spine (PNS) to the tip of soft palate (P).
Figure 4
Figure 4
Submental ultrasonography equipment, laser alignment (AmCad BioMed Corporation).
Figure 5
Figure 5
(a) The 30° segment of the upper airway; HM, hyoid-external meatus. (b) Transverse view of ultrasonographic images.
Figure 6
Figure 6
The scatter plots of significant correlation between cephalometric parameters and ultrasound parameters (airspace width).
Figure 7
Figure 7
The scatter plots of significant correlation between cephalometric parameters and ultrasound parameters (tongue width).
Figure 8
Figure 8
The scatter plots of significant correlation between cephalometric parameters and ultrasound parameters (superficial tissue thickness).
Figure 9
Figure 9
The scatter plots of significant correlation between cephalometric parameters and ultrasound parameters (deep tissue thickness).
See this image and copyright information in PMC

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