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Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

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Abstract

Objectives

This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes.

Materials and methods

Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4–6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson’s correlation and t-tests were applied.

Results

Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly.

Conclusions

The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment.

Clinical relevance

The craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.

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Acknowledgements

The authors express gratitude to the Coordination for the Improvement of Higher Education Personnel (CAPES) CAPES/PRINT—Call no. 41/2017 file number 88887.465681/2019-00 and to the Brazilian National Council for Scientific and Technological Development (CNPq), which provided Dr. Fabio Costa a PQ fellowship in category 2.

Funding

This study was funded in part by the Coordination for the Improvement of Higher Education Personnel (CAPES)—Finance Code 001, which supported a sandwich Doctorate Program. The research image analysis tools were supported by the National Institute of Dental and Craniofacial Research and the National Institute of Biomedical Imaging and Bioengineering under R01DE024450.

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Authors and Affiliations

  1. Department of Dental Clinic, School of Dentistry, Federal University of Ceara, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil

    Marcela Gurgel, Fabio Costa & Cauby Chaves Junior

  2. Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA

    Lucia Cevidanes, Antonio Ruellas & Jonas Bianchi

  3. Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil

    Rowdley Pereira, Paulo Cunali & Lia Bittencourt

  4. Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Antonio Ruellas

  5. Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA

    Jonas Bianchi

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  1. Marcela Gurgel
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  2. Lucia Cevidanes
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Contributions

Conceptualization and proof outline: [Marcela Gurgel], [Lucia Cevidanes], [Fabio Costa], [Rowdley Pereira], [Antonio Ruellas], [Jonas Bianchi], and [Cauby Chaves Junior]; Project administration and supervision: [Lucia Cevidanes], [Fabio Costa], and [Cauby Chaves Junior]; Methodology, Validation, and Writing — original draft: [Marcela Gurgel] and [Lucia Cevidanes]; Resources and sample: [Rowdley Pereira], [PauloCunali], and [Lia Bittencourt]; Writing — review & editing [All authors].

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Correspondence to Marcela Gurgel.

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The study was approved by the Research Ethics Committee of the Federal University of São Paulo, Brazil (number 0301/10). All volunteers signed the informed consent form (ICF).

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Gurgel, M., Cevidanes, L., Pereira, R. et al. Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes. Clin Oral Invest 26, 875–887 (2022). https://doi.org/10.1007/s00784-021-04066-5

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