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. 2025 Jun;172(6):2124-2133.
doi: 10.1002/ohn.1234. Epub 2025 Mar 19.

Minimal to Mean Airway Area Ratio of the Pharynx: A Novel Predictor of Pediatric Obstructive Sleep Apnea in Three-Dimensional Imaging

Kun-Tai Kang  1   2   3 , Yunn-Jy Chen  4   5 , Wen-Chin Weng  4   6 , Hung-Ta Hsiao  7 , Pei-Lin Lee  4   8 , Wei-Chung Hsu  1   4   9
Affiliations

Minimal to Mean Airway Area Ratio of the Pharynx: A Novel Predictor of Pediatric Obstructive Sleep Apnea in Three-Dimensional Imaging

Kun-Tai Kang et al. Otolaryngol Head Neck Surg. 2025 Jun.

Abstract

Objective: Reliable variables for detecting pediatric obstructive sleep apnea (OSA) using three-dimensional (3D) imaging are currently lacking. This study aimed to develop a novel predictor of OSA in children.

Study design: Prospective study.

Setting: Tertiary care children's hospital.

Methods: Pediatric patients (<18 years) with symptoms suggestive of OSA were enrolled. Polysomnography was used to categorize disease severities as primary snoring (apnea-hypopnea index, AHI < 1), mild OSA (AHI = 1-5), moderate OSA (AHI = 5-10), and severe OSA (AHI > 10). Cone-beam computed tomography was used to obtain 3D images. The minimal to mean airway area (AA) ratio was measured across the entire pharynx and its segment (nasopharynx, oropharynx, and hypopharynx).

Results: The study included 104 children. For the entire pharynx, the minimal to mean AA ratio was 0.41, 0.36, 0.35, and 0.25 in the primary snoring, mild OSA, moderate OSA, and severe OSA groups, respectively (P = .001). Pearson's correlation revealed an inverse relationship between the minimal to mean AA ratio and OSA severity. The receiver operating characteristic curve identified the optimal cutoff point for predicting AHI ≥ 1 as 0.34 in the oropharynx (area under the curve [AUC] = 71%) and 0.39 in the entire pharynx (AUC = 67%). The minimal to mean AA ratio in the nasopharynx or hypopharynx indicated no significant difference between OSA severities.

Conclusion: A minimal to mean airway AA ratio of less than one-third in the pharynx serves as a novel predictor of pediatric OSA in 3D imaging.

Keywords: child; cone‐beam computed tomography; polysomnography; sleep apnea syndromes; upper airway.

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