Relationship between surface facial dimensions and upper airway structures in obstructive sleep apnea.

STUDY OBJECTIVES We hypothesized that the facial phenotype is closely linked to upper airway anatomy. The aim of this study was to investigate the relationship between surface facial dimensions and upper airway structures using magnetic resonance imaging (MRI) in subjects with obstructive sleep apnea (OSA). DESIGN Cohort study. SETTING Sleep investigation unit. PATIENTS Sixty-nine patients (apnea-hypopnea index > or = 10/h) underwent MRI as part of a study of upper airway anatomy in oral appliance therapy. INTERVENTIONS Measurements of a range of surface facial dimensions and upper airway soft tissue volumes were performed on the MR images using image-analysis software. Pearson correlation analyses were performed. MEASUREMENTS AND RESULTS Significant correlations were identified between a number of surface facial dimensions and neck circumference. Significant positive correlations were demonstrated between surface facial dimensions (including facial widths, facial heights, nose width, interocular and intercanthal widths) and upper airway structures. The strongest associations were between the tongue volume and the midface width (r = 0.70, P < 0.001), and lower-face width (r = 0.60, P <0.001). Surface facial dimensions in combination were also strong determinants for tongue volume (r2 = 0.69). Correlations between surface soft tissue thickness and upper airway soft tissue volumes occurred at the level of the midface but not at the level of the lower face. CONCLUSIONS This study demonstrates that there is a relationship between surface facial dimensions and upper airway structures in subjects with OSA. These findings support the potential role of surface facial measurements in anatomic phenotyping for OSA.

[1]  T. Prvan,et al.  Prediction of obstructive sleep apnea with craniofacial photographic analysis. , 2009, Sleep.

[2]  J. Dempsey,et al.  Anatomic determinants of sleep-disordered breathing across the spectrum of clinical and nonclinical male subjects. , 2002, Chest.

[3]  H. Tanzawa,et al.  Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing. , 2002, American journal of respiratory and critical care medicine.

[4]  P. Cistulli,et al.  A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. , 2001, American journal of respiratory and critical care medicine.

[5]  S. Redline,et al.  The genetics of sleep apnea. , 2000, Sleep medicine reviews.

[6]  J. Levine,et al.  Relation between chubby cheeks and visceral fat. , 1998, The New England journal of medicine.

[7]  K. Bailey,et al.  Relationships between insulin sensitivity and measures of body fat in asymptomatic men and women. , 2004, Obesity research.

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

[9]  T. Davidson,et al.  Lingual Fat at Autopsy , 2007, The Laryngoscope.

[10]  P. Cistulli,et al.  Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial. , 2009, Sleep.

[11]  N. Douglas,et al.  A cephalometric comparison of patients with the sleep apnea/hypopnea syndrome and their siblings. , 2005, Sleep.

[12]  T. Nishino,et al.  Anatomical Balance of the Upper Airway and Obstructive Sleep Apnea , 2008, Anesthesiology.

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

[14]  E. Salter,et al.  Craniofacial Anthropometry: Practical Measurement of the Head and Face for Clinical, Surgical, and Research Use , 1997 .

[15]  T. Young,et al.  Excess weight and sleep-disordered breathing. , 2005, Journal of applied physiology.

[16]  Zi-Jun Liu,et al.  Effects of tongue volume reduction on craniofacial growth: A longitudinal study on orofacial skeletons and dental arches. , 2008, Archives of oral biology.

[17]  Raanan Arens,et al.  Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. , 2003, American journal of respiratory and critical care medicine.

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

[19]  R. Fränkel,et al.  Orofacial Orthopedics With the Function Regulator , 1989 .

[20]  Ronald R Grunstein,et al.  Craniofacial phenotyping in obstructive sleep apnea--a novel quantitative photographic approach. , 2009, Sleep.

[21]  E. Sforza,et al.  Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. , 2000, American journal of respiratory and critical care medicine.

[22]  R. Schwab.  Genetic determinants of upper airway structures that predispose to obstructive sleep apnea , 2005, Respiratory Physiology & Neurobiology.

[23]  J. Ovesen,et al.  Head posture in obstructive sleep apnoea. , 1993, European journal of orthodontics.

[24]  D. Ala'aldeen,et al.  Mastic gum kills Helicobacter pylori. , 1998, The New England journal of medicine.

[25]  A. Rechtschaffen.  A manual of standardized terminology, techniques and scoring system for sleep of human subjects , 1968 .

[26]  S. Nakata,et al.  Relationship between tongue volume and lower dental arch sizes. , 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.

[27]  T.W.Sadler.  Langman's Medical Embryology , 1969 .

[28]  S Adachi,et al.  Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. , 1995, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[29]  K. Takada,et al.  Tongue Volume in Human Female Adults with Mandibular Prognathism , 1996, Journal of dentistry research.

[30]  H. Rockette,et al.  Craniofacial structure and obstructive sleep apnea syndrome--a qualitative analysis and meta-analysis of the literature. , 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.

[31]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .

[32]  M G Hans,et al.  The relationship between craniofacial morphology and obstructive sleep apnea in whites and in African-Americans. , 2001, American journal of respiratory and critical care medicine.

[33]  A. Samsudin,et al.  Craniofacial obesity in patients with obstructive sleep apnea , 2009, Sleep and Breathing.

[34]  Raanan Arens,et al.  A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. , 2002, Sleep.

[35]  Bruce D Johnson,et al.  Facial fat and its relationship to abdominal fat: a marker for insulin resistance? , 2004, Medical hypotheses.

[36]  C. Guilleminault,et al.  Obstructive sleep apnea and abnormal cephalometric measurements. Implications for treatment. , 1984, Chest.