Skip to main content

Advertisement

SpringerLink
Log in

Correlation of Various Anthropometric and Craniofacial Variables with Severity of Obstructive sleep Apnea in Indian Population

  • Original Article
  • Published:
Sleep and Vigilance Aims and scope Submit manuscript

Abstract

Background

Ethnic craniofacial morphology differences significantly affect upper airway caliber and thus apnea–hypopnea index (AHI). As there is very limited data available from India regarding factors influencing severity of obstructive sleep apnea (OSA), we tried to explore whether anthropometric and craniofacial variable predict severity of OSA.

Aims

To find out correlation of simple clinical examination of craniofacial morphology and anthropometric measurements with severity of OSA in Indian population.

Method

We studied consecutive OSA patients between June 2015 and September 2016. Detailed history, physical examination (including anthropometry, clinical craniofacial assessment) and Level I polysomnography was done. Anthropometric and craniofacial parameters were correlated with AHI, nadir oxygen and percent of total time with oxygen saturation level lower than 90% during sleep (T < 90%).

Results

Out of 193 patients, 148 (76.6%) were males and 45 (23.3%) were females with ratio of 3.28:1. Mean age, mean body mass index (BMI) and mean AHI of cohort were 50.24 ± 1.65 years, 30.20 ± 0.84 kg/m2, and 53.83 ± 4.8 events per hour, respectively. With respect to AHI, nadir oxygen and T < 90%, statistically significant correlation was found for modified Mallampati class (p value = 0.001, = 0.009, = 0.002, respectively), waist circumference (p value = 0.002, < 0.001, = 0.001, respectively), neck circumference (p value < 0.001, < 0.001, < 0.001, respectively), BMI WHO cut off (p value < 0.001, < 0.001, < 0.001, respectively), and BMI Asian Indian cut off (p value = 0.001, < 0.001, < 0.001, respectively).

Conclusion

Anthropometric and craniofacial variables are easy to perform clinical examinations. Higher modified Mallampati class, WC, NC, BMI, large tonsils and micrognathia are associated with more severe OSA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien: American Academy of Sleep Medicine; 2014.

    Google Scholar 

  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occur-rence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    Article  CAS  Google Scholar 

  3. RacioneroCasero MA, GarcíaRío F, PinoGarcía JM, Prados Sánchez C, DíazLobato S, Villamor León J. The sleep apnea syndrome as a health problem. An estimation of its prevalence and morbimortality. An Med Interna. 1999;16:97–102.

    CAS  Google Scholar 

  4. Hui DS. Craniofacial profile assessment in patients with obstructive sleep apnea. Sleep. 2009;32:11–2.

    PubMed  PubMed Central  Google Scholar 

  5. Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest. 2006;130:149–56.

    Article  Google Scholar 

  6. Kim J, In K, Kim J, You S, Kang K, Shim J, et al. Prevalence of sleep-disordered breath-ing in middle-aged Korean men and women. Am J Respir Crit Care Med. 2004;170:1108–13.

    Article  Google Scholar 

  7. Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med. 2004;169:168–73.

    Article  Google Scholar 

  8. Dubey A, Upadhyay S, Mathur S, Kant S, Singh BP, Rakesh Makwana R. Comparative evaluation of craniofacial anthropometric measurements in indian adult patients with and without obstructive sleep apnea: a pilot study. J Indian Prosthodont Soc. 2015;15:331–6.

    Article  Google Scholar 

  9. Hui DS, Ko FW, Chu AS, Fok JP, Chan MC, Li TS, et al. Cephalometric assessment of craniofacial morphology in Chinese patients with obstructive sleep apnoea. Respir Med. 2003;97:640–6.

    Article  CAS  Google Scholar 

  10. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation presented at: the World Health Organization; June 3–5, 1997; Geneva, Switzerland. Publication WHO/NUT/NCD/98.1. http://apps.who.int/iris/handle/10665/63854. Accessed 5 July 2017.

  11. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–70.

    CAS  PubMed  Google Scholar 

  12. MESA exam 1–4 Protocol. MESA Overview and Protocol. https://www.mesa-nhlbi.org/aboutMESAOverviewProtocol.aspx. Accessed 5 July 2017.

  13. The IDF consensus worldwide defi-nition of the metabolic syndrome. International diabetes federation, 2006. https://www.idf.org/webdata/docs/MetS_def_update2006.pdf. Accessed 5 July 2017.

  14. World Health Organization. Waist circumference and waist-hip ratio:report of a WHO expert consultation,Geneva, 8–11 December 2008. Geneva: World Health Organization 2011. http://www.who.int/iris/handle/10665/44583. Accessed 5 July 2017.

  15. Subramanian S, Jayaraman G, Majid H, et al. Influence of gender and anthropometric measures on severity of obstructive sleep apnea. Sleep Breath. 2012;16:1091. https://doi.org/10.1007/s11325-011-0607-9.

    Article  CAS  PubMed  Google Scholar 

  16. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42:487–90.

    Article  CAS  Google Scholar 

  17. Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999;109:1901–7.

    Article  CAS  Google Scholar 

  18. Allanson JE, Cunniff C, Hoyme HE, McGaughran J, Muenke M, Neri G. Elements of Morphology: standard Terminology for the Head and Face. Am J Med Genet A. 2009;149A:6–28.

    Article  Google Scholar 

  19. Carey JC, Cohen MM Jr, Curry CJR, Devriendt K, Holmes LB, Verloes A. Elements of Morphology: standard Terminology for the lips, mouth, and oral region. Am J Med Genet A. 2009;149A:77–92.

    Article  Google Scholar 

  20. Graber TM. Orthodontics: principles and practice. 3rd ed. Philadelphia: W. B. Saunders; 1972.

    Google Scholar 

  21. Tikanto J, Pirilä T. Effects of the Cottle’s maneuver on the nasal valve as assessed by acoustic rhinometry. Am J Rhinol. 2007;21:456–9.

    Article  Google Scholar 

  22. Balaji SM. Reduction glossectomy for large tongues. Ann Maxillofac Surg. 2013;3:167–72.

    Article  CAS  Google Scholar 

  23. Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL et al. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, Version 2.1. Darien, Illinois: American academy of sleep medicine; 2014. www.aasmnet.org. Accessed 5 July 2017.

  24. Rodrigues MM, Dibbern RS, Goulart CW. Nasal obstruction and high Mallampati score as risk factors for obstructive sleep apnea. Braz J Otorhinolaryngol. 2010;76:596–9.

    Article  Google Scholar 

  25. Wong ML, Sandham A, Ang PK, Wong DC, Tan WC, Huggare J. Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: an inter-ethnic comparison. Eur J Orthod. 2005;27:91–7.

    Article  Google Scholar 

  26. Zonato AI, Bittencourt LR, Martinho FL, Júnior JF, Gregório LC, Tufik S. Association of systematic head and neck physical examination with severity of obstructive sleep apnea–hypopnea syndrome. Laryngoscope. 2003;113:973–80.

    Article  Google Scholar 

  27. Cahali MB, Soares CF, Dantas DA, Formigoni GG. Tonsil volume tonsil grade and obstructive sleep apnea: is there any meaningful correlation. Clinics (Sao Paulo). 2011;66:1347–52.

    Article  Google Scholar 

  28. Erdamar B, Suoglu Y, Cuhadaroglu C, Katircioglu S, Guven M. Evaluation of clinical parameters in patients with obstructive sleep apnea and possible correlation with the severity of the disease. Eur Arch Otorhinolaryngol. 2001;258:492–5.

    Article  CAS  Google Scholar 

  29. Tong M, Xia X, Cao E. Cephalometric analysis of the craniofacial bony structures in patients with obstructive sleep apnea. ZhonghuaJie He He Hu Xi Za Zhi. 1999;22:335–7.

    CAS  Google Scholar 

  30. Lowe AA, Fleetham JA, Adachi S, Ryan CF. Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop. 1995;107:589–95.

    Article  CAS  Google Scholar 

  31. Wysocki J, Charuta A, Kowalcze K, Ptaszyńska-Sarosiek I. Anthropometric and physiologic assessment in sleep apnoea patients regarding body fat distribution. Folia Morphol (Warsz). 2016;75:393–9.

    Article  CAS  Google Scholar 

  32. Pinto JA, Godoy LB, Marquis VW, Sonego TB, Leal Cde F, Artico MS. Anthropometric data as predictors of obstructive sleep apnea severity. Braz J Otorhinolaryngol. 2011;77:516–21.

    Article  Google Scholar 

  33. Sreedharan SE, Agrawal P, Rajith RS, Nair S, Sarma SP, Radhakrishnan A. Clinical and polysomnographic predictors of severe obstructive sleep apnea in the South Indian population. Ann Indian Acad Neurol. 2016;19:216–20.

    Article  Google Scholar 

  34. Borges PTM, Filho ESF, Araujo TME, Neto JMM, Borges NES, Neto BM, et al. Correlation of cephalometric and anthropometric measures with obstructive sleep apnea severity. Int Arch Otorhinolaryngol. 2013;17:321–8.

    PubMed  PubMed Central  Google Scholar 

  35. Leitzen KP, Brietzke SE, Lindsay RW. Correlation between nasal anatomy and objective obstructive sleep apnea severity. Otolaryngol Head Neck Surg. 2014;150:325–31.

    Article  Google Scholar 

  36. Hukins C. Mallampati class is not useful in the clinical assessment of sleep clinic patients. J Clin Sleep Med. 2010;6:545–9.

    PubMed  PubMed Central  Google Scholar 

  37. Yagi H, Nakata S, Tsuge H, Yasuma F, Noda A, Morinaga M, et al. Morphological examination of upper airway in obstructive sleep apnea. Auris Nasus Larynx. 2009;36:444–9.

    Article  Google Scholar 

  38. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med. 1998;157:144–8.

    Article  CAS  Google Scholar 

  39. Grunstein R, Wilcox I, Yang TS, Gould Y, Hedner J. Snoring and sleep apnoea in men: association with central obesity and hypertension. Int J Obes Relat Metab Disord. 1993;17:533–40.

    CAS  PubMed  Google Scholar 

  40. Kang HH, Kang JY, Ha JH, Lee J, Kim SK, Moon HS, et al. The associations between anthropometric indices and obstructive sleep apnea in a Korean population. PLoS One. 2014;9:e114463. https://doi.org/10.1371/journal.pone.0114463.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Pulmonary Medicine, AIIMS, Bhopal, India

    Kamendra Singh Pawar, Abhishek Goyal & Alkesh Khurana

  2. Community and Family Medicine, AIIMS, Bhopal, India

    Abhijit Pakhare

Authors
  1. Kamendra Singh Pawar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abhishek Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alkesh Khurana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abhijit Pakhare
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abhishek Goyal.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pawar, K.S., Goyal, A., Khurana, A. et al. Correlation of Various Anthropometric and Craniofacial Variables with Severity of Obstructive sleep Apnea in Indian Population. Sleep Vigilance 2, 127–133 (2018). https://doi.org/10.1007/s41782-018-0045-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41782-018-0045-x

Keywords

Search

Navigation