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Craniofacial morphology and obstructive sleep apnoea-hypopnoea syndrome: a craniometric comparative analysis

Morfologia craniofacciale e sindrome delle apnee-ipopnee ostruttive nel sonno: un’analisi craniometrica comparativa

  • Paediatric Radiology / Radiologia Pediatrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to define the relationship between paediatric obstructive sleep apnoea-hypopnea syndrome (OSAHS) and craniofacial morphovolumetric features through comparative craniometric analyses between affected children and controls based on conventional cephalometry.

Materials and methods

Cephalometric examinations of 40 children affected by OSAHS were retrospectively evaluated. Sixteen craniometric landmarks were identified, and 27 linear and angular indices related to craniofacial morphovolumetric features were measured. Subsequently, the same process of identifying landmarks and measuring indices was performed on the cephalometric examinations of 40 controls. For each index, we then calculated in both groups the mean, standard deviation, standard error and p value. By comparing the values obtained in the two series, we calculated the degree of significance of each difference between children with OSAHS and controls using the Student t test.

Results

Differences of only 5/27 linear and angular indices considered were not statistically significant between groups, thus confirming susceptibility to the disorder in relation to certain splanchnocranic morphovolumetric features. The most significant differences involved mandibular plane inclination and distance between landmark sella and hyoid bone, a reliable index being the vertical position of the latter.

Conclusions

Despite the limitations associated with the 2D nature of conventional cephalometry, mainly related to projection and identification errors, and despite the upright position during examination, we consider the diagnostic value and information content of this technique high, thus reaffirming its role as a first-line imaging investigation in children with sleep-related breathing disorders.

Riassunto

Obiettivo

Scopo del nostro studio è stato definire la possibile correlazione tra la sindrome delle apnee-ipopnee ostruttive del sonno (OSAHS) pediatrica con determinate caratteristiche morfovolumetriche dello scheletro craniofacciale attraverso un’analisi craniometrica comparativa basata sulla cefalometria convenzionale tra bambini affetti e controlli.

Materiali e metodi

Sono stati valutati retrospettivamente gli esami cefalometrici di quaranta bambini affetti da OSAHS. Sono stati identificati sedici punti craniometrici e misurati ventisette indici lineari ed angolari riferiti alle caratteristiche morfovolumetriche dello scheletro craniofacciale. Successivamente, lo stesso procedimento di identificazione dei punti e misurazione degli indici è stato effettuato sugli esami cefalometrici di quaranta controlli. Per ciascuno degli indici ottenuti, poi, abbiamo calcolato nei due gruppi media, deviazione standard, errore standard e valore del test t di Student. Dal confronto dei valori ottenuti nelle due serie abbiamo infine calcolato attraverso il test t di Student il grado di significatività della differenza tra i bambini affetti da OSAHS ed i controlli.

Risultati

Le differenze di solo cinque dei ventisette indici lineari ed angolari valutati non sono risultate statisticamente significative tra i due gruppi, confermando la predisposizione al disturbo determinata da un particolare assetto dello splancnocranio. Le differenze più significative hanno riguardato l’inclinazione del piano mandibolare e la distanza tra la sella e l’osso ioide, indice affidabile della posizione verticale di quest’ultimo.

Conclusioni

Nonostante i limiti legati alla natura bidimensionale dell’indagine cefalometrica convenzionale, principalmente correlati agli errori di proiezione e di identificazione, e nonostante l’esecuzione dell’esame in posizione eretta, consideriamo elevato il valore diagnostico dell’indagine ed il suo contenuto informativo, riaffermando cosÌ il suo ruolo di indagine di imaging prima istanza nei bambini con disturbi del respiro legati al sonno.

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References/Bibliografia

  1. Fregosi RF, Quan SF, Kaemingk KL et al (2003) Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children. J Appl Physiol 95:2030–2038

    PubMed  CAS  Google Scholar 

  2. Marcus CL (2000) Pathophysiology of childhood obstructive sleep apnea: current concepts. Respiration Pathology 119:143–154

    CAS  Google Scholar 

  3. Pirila-Parkkinen K, Lopponen H, Nieminem P et al (2010) Cephalometric evaluation of children with nocturnal sleep — disordered breathing. Eur J Orthod 32:662–671

    Article  PubMed  Google Scholar 

  4. Finkelstein Y, Wexler D, Berger G et al (2000) Anatomical basis of sleeprelated breathing abnormalities in children with nasal obstruction. Arch Otolaryngol Head Neck Surg 126:593–600

    PubMed  CAS  Google Scholar 

  5. Vieira BB, Itikawa CE, de Almeida LA et al (2011) Cephalometric evaluation of facial pattern and hyoid bone position in children with obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 75:383–386

    Article  PubMed  Google Scholar 

  6. Kikuchi M, Higurashi N, Miyazaki S, Itasaka Y (2000) Facial patterns of obstructive sleep apnea patients using Ricketts’ method. Psychiatry Clin Neurosci 54:336–337

    Article  PubMed  CAS  Google Scholar 

  7. Cistulli P (1996) Craniofacial abnormalities in obstructive sleep apnoea. Respirology 3:167–174

    Article  Google Scholar 

  8. Kawashima S, Peltomaki T, Sakata H et al (2002) Craniofacial morphology in preschool children with sleep-related breathing disorder and hypertrophy of tonsils. Acta Paediatr 91:71–77

    Article  PubMed  CAS  Google Scholar 

  9. Hoekema A, Hovinga B, Stegenga B, De Bont LGM (2003) Craniofacial morphology and obstructive sleep apnoea: a cephalometric analysis. J Oral Rehab 30:690–696

    Article  CAS  Google Scholar 

  10. Pracharktam N, Hans M, Strohl KP (1994) Upright and supine cephalometric evaluation of obstructive sleep apnoea syndrome and snoring subjects. Ann Orthod 64:63–73

    CAS  Google Scholar 

  11. Dahlberg G (1940) Statistical methods for medical and biological students. George Allen & Unwin, London

    Google Scholar 

  12. Houston WJ, Maher RE, McElroy D, Sheriff M (1986) Sources of error in measurements from cephalometric radiographs. Eur J Orthod 8:149–151

    Article  PubMed  CAS  Google Scholar 

  13. Paoli JR, Lauwers F, Lacassagne L et al (2001) Craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: cephalometric study in 85 patients. Br J Oral Maxillofac Surg 39:40–45

    Article  PubMed  CAS  Google Scholar 

  14. Carotenuto M, Esposito M, Pascotto A (2011) Facial patterns and primary nocturnal enuresis in children. Sleep Breath 15:221–227

    Article  PubMed  Google Scholar 

  15. Zucconi M, Caprioglio A, Calori G et al (1999) Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case-control study. Eur Resp J 13:411–417

    Article  CAS  Google Scholar 

  16. Warren DW (1990) Effect of airway obstruction upon facial growth. Otolaryngol Clin North Am 23:699–712

    PubMed  CAS  Google Scholar 

  17. Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 9:469–477

    PubMed  CAS  Google Scholar 

  18. Andersson L, Brattstrom V (1991) Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome. Int J Oral and Maxillofac Surg 20:159–162

    Article  CAS  Google Scholar 

  19. Lowe AA (2006) Orthodontists and sleep-disordered breathing. Am J Orthod Dentofacial Orthop 129:194

    Article  PubMed  Google Scholar 

  20. Zettergren-Wijk L, Forsberg CM, Linder-Aronson S (2006) Changes in dentofacial morphology after adenotonsillectomy in young children with obstructive sleep apnoea. A 5-year follow-up study. Eur J Orthod 28:319–326

    Article  PubMed  Google Scholar 

  21. Juliano ML, Machado MAC, de Carvalho LBC, Do Prado LBF (2009) Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome. Arq Neuropsiquiatr 67:860–865

    Article  PubMed  Google Scholar 

  22. Lieberman DE, Krovitz GE, Yates FW et al (2004) Effects of food processing on masticatory strain and craniofacial growth in a retrognathic face. J Hum Evol 46:655–677

    Article  PubMed  Google Scholar 

  23. Defraia E, Camporesi M, Marinelli A, Tollaro I (2008) Morphometric investigation in the skulls of young adults. A comparative study between 19th century and modern Italian samples. Angle Orthod 78:641–646

    Article  Google Scholar 

  24. Bastir M, Rosas A (2004) Facial heights: evolutionary relevance of postnatal ontogeny for facial orientation and skull morphology in humans and chimpanzees. J Hum Evol 47:359–381

    Article  PubMed  Google Scholar 

  25. Bacon WH, Krieger J, Turlot JC, Stierle JL (1988) Craniofacial characteristics in patients with obstructive sleep apnea syndrome. Cleft Palate J 25:374–378

    PubMed  CAS  Google Scholar 

  26. Djupesland G, Lyberg T, Krogstad O (1987) Cephalometric analysis and surgical treatment of patients with obstructive sleep apnea syndrome. Acta Otolaryngol 103:551–557

    PubMed  CAS  Google Scholar 

  27. Strelzow VV, Blanks RH, Basile A, Strelzow AE (1988) Cephalometric airway analysis in obstructive sleep apnea syndrome. Laryngoscope 98:1149–1158

    Article  PubMed  CAS  Google Scholar 

  28. Maltais F, Carrier G, Cormier Y, Series F (1991) Cephalometric measurements in snorers, non-snorers and patients with sleep apnoea. Thorax 46:419

    Article  PubMed  CAS  Google Scholar 

  29. Huggare JA, Laine Alava T (1997) Nasorespiratory function and head posture. Am J Orthod Dentofac Orthoped 112:507–511

    Article  CAS  Google Scholar 

  30. Susarla SM, Abramson ZR, Dodson TB, Kaban LB (2011) Upper airway length decreases after maxillomandibular advancement in patients with obstructive sleep apnea. J Oral Maxillofac Surg 69:2872–2878

    Article  PubMed  Google Scholar 

  31. Lyberg T, Krogstad G, Djupesland G (1989) Cephalometric analysis in patients with obstructive sleep apnoea syndrome. I. Skeletal morphology. J Laryngol Otol 103:287–292

    Article  CAS  Google Scholar 

  32. Guilleminault C. Riley P, Powell N (1984) Obstructive sleep apnoea and abnormal cephalometric measurements, implications for treatment. Chest 86:793–794

    Article  PubMed  CAS  Google Scholar 

  33. Riley RW, Guilleminault C, Herran J, Powell N (1983) Cephalometric analysis and flow — volume loops in obstructive sleep apnea patients. Sleep 6:303–311

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Odontoiatria, Facoltà di Medicina e Chirurgia, Seconda Università di Napoli, Via De Crecchio 6, 80131, Napoli, Italy

    L. Perillo & L. Cristallo

  2. Sezione Scientifica di Radiologia, Unità di Radiologia, Radioterapia, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi, A. Lanzara”, e Medicina Nucleare, Seconda Università di Napoli, Primo Policlinico di Napoli, Piazza Miraglia 5, 80131, Napoli, Italy

    S. Cappabianca, M. Montemarano, A. Negro, A. Basile, F. Iaselli & A. Rotondo

  3. Corso Trieste 273, 81100, Caserta, Italy

    F. Iaselli

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  1. L. Perillo
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  2. S. Cappabianca
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  3. M. Montemarano
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  4. L. Cristallo
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  6. A. Basile
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  7. F. Iaselli
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  8. A. Rotondo
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Correspondence to F. Iaselli.

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Perillo, L., Cappabianca, S., Montemarano, M. et al. Craniofacial morphology and obstructive sleep apnoea-hypopnoea syndrome: a craniometric comparative analysis. Radiol med 118, 648–659 (2013). https://doi.org/10.1007/s11547-012-0904-9

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  • DOI: https://doi.org/10.1007/s11547-012-0904-9

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