The relationship between craniofacial morphology and obstructive sleep apnea in whites and in African-Americans.

Previous studies of craniofacial risk factors for obstructive sleep apnea (OSA) have been based predominantly on cephalometry. However, differences in head form (measured by the cranial index [CI]) and facial form (measured by the facial index [FI]) are considered by anthropologists to provide a basis for structural variation in craniofacial anatomy. We assessed the association of head and facial form with the apnea hypopnea index (AHI) in 364 white individuals and 165 African-Americans. Data collected included cranial and facial dimensions (using anthropometric calipers), body mass index (BMI), neck circumference, and the AHI. CI and FI differed for whites with OSA (AHI > or = 15) versus those without OSA (AHI < 5) (increased CI and decreased FI in subjects with OSA, p = 0.005 and p = 0.006, respectively). CI and FI did not differ in OSA versus non-OSA groups of African-Americans. In subjects with OSA, the CI in whites was again greater and the FI smaller than those in African-Americans (p = 0.007 and p = 0.004, for CI and FI.) We conclude that brachycephaly is associated with an increased AHI in whites but not in African-Americans. The CI may useful in phenotyping and identifying population subsets with OSA.

[1]  K. Strohl,et al.  Physiologic basis of therapy for sleep apnea. , 1987, The American review of respiratory disease.

[2]  J. Fleetham,et al.  Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis. , 2009, The Angle orthodontist.

[3]  S. Redline,et al.  Cephalometric assessment in obstructive sleep apnea. , 1996, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[4]  M. Hans,et al.  Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. , 1997, Chest.

[5]  A A Lowe,et al.  The relationship between obesity and craniofacial structure in obstructive sleep apnea. , 1995, Chest.

[6]  M Partinen,et al.  Women and the obstructive sleep apnea syndrome. , 1988, Chest.

[7]  G Djupesland,et al.  Cephalometric analysis in patients with obstructive sleep apnoea syndrome. , 1989, The Journal of Laryngology & Otology.

[8]  A J Block,et al.  Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. , 1979, The New England journal of medicine.

[9]  S. A. Knight.  Methods of measurement , 1988 .

[10]  T. Lyberg,et al.  Obstructive sleep apnoea: a cephalometric study. Part II. Uvulo-glossopharyngeal morphology. , 1995, European journal of orthodontics.

[11]  J. Fleetham,et al.  Facial morphology and obstructive sleep apnea. , 1986, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[12]  P. Suratt,et al.  Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. , 2015, The American review of respiratory disease.

[13]  A A Lowe,et al.  Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults. , 1998, European journal of orthodontics.

[14]  B Solow,et al.  Head posture and craniofacial morphology. , 1976, American journal of physical anthropology.

[15]  M G Hans,et al.  The association of sudden unexpected infant death with obstructive sleep apnea. , 1996, American journal of respiratory and critical care medicine.

[16]  J. Krieger,et al.  Cephalometric evaluation of pharyngeal obstructive factors in patients with sleep apneas syndrome. , 1990, The Angle orthodontist.

[17]  Shepard Jw,et al.  Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. , 1992 .

[18]  G Djupesland,et al.  Cephalometric analysis in patients with obstructive sleep apnoea syndrome. , 1989, The Journal of Laryngology & Otology.

[19]  S. Redline,et al.  Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device. , 1991, Chest.

[20]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[21]  J. Fleetham,et al.  Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. , 1996, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[22]  A I Pack,et al.  Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. , 1993, The American review of respiratory disease.

[23]  Arthur S Slutsky,et al.  Do patients with obstructive sleep apnea have thick necks? , 1990, The American review of respiratory disease.

[24]  J. Battagel.  Obstructive Sleep Apnoea: Fact Not Fiction * , 1996, British journal of orthodontics.

[25]  P. L. Smith,et al.  Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness. , 1983, The American review of respiratory disease.

[26]  J. Krieger,et al.  Craniofacial characteristics in patients with obstructive sleep apneas syndrome. , 1988, The Cleft palate journal.

[27]  H. Kraemer,et al.  Risk Factors for Sleep Disordered Breathing in Heterogeneous Geriatric Populations , 1987, Journal of the American Geriatrics Society.

[28]  M Partinen,et al.  Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. , 1990, Chest.

[29]  S. Redline,et al.  The familial aggregation of obstructive sleep apnea , 1995 .

[30]  S. Redline,et al.  Racial differences in sleep-disordered breathing in African-Americans and Caucasians. , 1997, American journal of respiratory and critical care medicine.

[31]  H. Fields,et al.  Relationship between vertical dentofacial morphology and respiration in adolescents. , 1991, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.