Sleep and Breathing

, Volume 16, Issue 4, pp 1219–1227 | Cite as

A case–control study of craniofacial features of children with obstructed sleep apnea

  • Jinrong Deng
  • Xuemei Gao
Original Article



This study aims to analyze differences in the skeletal, dental, and soft tissue components of craniofacial structure predisposing to the pediatric obstructive sleep apnea, by a comparison of the cephalograms between children with obstructive sleep apnea (OSA) and controls.

Materials and methods

The study enrolled a total of 30 children who were composed of the following two groups: 15 OSA patients and 15 controls. The two groups were strictly matched by age and sex. Lateral head radiographs were obtained and then cephalometric measurements were compared between the two. Fifty-six measurements were determined to study various skeletal, soft tissue, and airway structure.


Marked differences were demonstrated in terms of SNB, PG-NB, lower facial height, H-C3Me, and adenoid (A) and tonsil (T/P). The SNB angle (75.82 ± 4.30) in case group was smaller than in the control (78.71 ± 2.61; p = 0.035), the PG/NB value in case group (1.32 ± 0.84 mm) was higher than that in the control (0.62 ± 0.60 mm; p = 0.015). The anterior lower facial height was 65.12 ± 5.91 mm in case group (p = 0.048), while the anterior lower facial height in control was 61.51 ± 3.22 mm. The position of hyoid was lower in case group (5.30 ± 3.67 mm) compared with the control one (2.64 ± 2.58 mm; p = 0.029). Furthermore, the patients with OSA had larger As and T/Ps than the controls.


The case group differed from the control group in the length of mandible, anterior lower facial height, position of hyoid and the chin, and the size of the As and T/Ps.


Pediatric sleep apnea syndrome Craniofacial features PSG Cephalometrics 



This study was supported by grants from Capital Research Fund of Science Development (2007–3009) and National Science Foundation of China (30872915).

Conflict of interest

We declare that we have no conflict of interest in the authorship or publication of this contribution and no presentation at any conference.


  1. 1.
    American Thoracic Society (1996) Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 153:866–878Google Scholar
  2. 2.
    Li AM, Au CT, So HK, Lau J, Ng PC, Wing YK (2010) Prevalence and risk factors of habitual snoring in primary school children. Chest 138:519–527CrossRefPubMedGoogle Scholar
  3. 3.
    Guilleminault C, Lee JH, Chan A (2005) Pediatric obstructive sleep apnea syndrome. Arch Pediatr Adolesc Med 159:775–785CrossRefPubMedGoogle Scholar
  4. 4.
    Trrenouth MJ, Timms DJ (1999) Relationship of the functional oropharynx to craniofacial morphology. Angle Orthod 69:419–423Google Scholar
  5. 5.
    Enlow DH, Takayuki K, Arthur BL (1971) The morphological and morphogenetic basis for craniofacial form and pattern. Angle Orthod 41:161–188PubMedGoogle Scholar
  6. 6.
    Johns FR, Strollo PJ, Buckleyet M, Constantino J (1998) The influence of craniofacial structure on obstructive sleep apnea in young adults. J Oral Maxillofac Surg 56:596–602CrossRefPubMedGoogle Scholar
  7. 7.
    Riha RL, Brander P, Vennelleet M, Douglas NJ (2005) A cephalometric comparison of patients with the sleep apnea/hypopnea syndrome and their siblings. Sleep 28:315–320PubMedGoogle Scholar
  8. 8.
    Partinen M, Guilleminault C, Quera-Salva MA, Jamieson A (1988) Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest 93:1199–1205CrossRefPubMedGoogle Scholar
  9. 9.
    Bernard DB, Andrzej K, Robert HB (1988) Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 98:226–234Google Scholar
  10. 10.
    Tangugsorn V, Skatvedt O, Krogstad O, Lyberg T (1995) Obstructive sleep apnoea: a cephalometric study. Part I. Cervico-craniofacial skeletal morphology. Eur J Orthod 17:45–56PubMedGoogle Scholar
  11. 11.
    Ekici M, Ekici A, Keles H, Akin A, Karlidag A, Tunckol M, Kocyigit P (2008) Risk factors and correlates of snoring and observed apnea. Sleep Med 9:290–296CrossRefPubMedGoogle Scholar
  12. 12.
    Tsuda H, Fastlicht S, Almeida FR, Lowe AA (2011) The correlation between craniofacial morphology and sleep-disordered breathing in children in an undergraduate orthodontic clinic. Sleep Breath 15:163–171CrossRefPubMedGoogle Scholar
  13. 13.
    Lowe AA, Ono T, Ferguson KA, Pae EK, Ryan CF, Fleetham JA (1996) Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 110:653–664CrossRefPubMedGoogle Scholar
  14. 14.
    Acebo C, Millman RP, Rosenberg C, Cavallo A, Carskadon MA (1996) Sleep, breathing and cephalometric in older children and young adults. Part I. Normative values. Chest 109:664–672CrossRefPubMedGoogle Scholar
  15. 15.
    Hans MG, Nelson S, Pracharktam N, Baek SJ, Strohl K, Redline S (2001) Subgrouping persons with snoring and/or apnea by using anthropometric and cephalometric measures. Sleep Breath 5:79–91CrossRefPubMedGoogle Scholar
  16. 16.
    Baik UB, Suzuki M, Ikeda K, Sugawara J, Mitani H (2002) Relationship between cephalometric characteristics and obstructive sites in obstructive sleep apnea syndrome. Angle Orthod 72:124–134PubMedGoogle Scholar
  17. 17.
    Özdemir H, Altin R, Söğüt A, Cinar F, Mahmutyazicioğlu K, Kart L, Uzun L, Davşanci H, Gündoğdu S, Tomaç N (2004) Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients. Pediatr Radiol 34:393–399CrossRefPubMedGoogle Scholar
  18. 18.
    Karlsen AT (2004) Association between vertical development of the cervical spine and the face in subjects with varying vertical facial patterns. Am J Orthod Dentofacial Orthop 125:597–606CrossRefPubMedGoogle Scholar
  19. 19.
    Behlfelt K, Linder-Aronson S, McWilliam J (1989) Dentition in children with enlarged tonsils compared to control children. Eur J Orthod 11:416–429PubMedGoogle Scholar
  20. 20.
    Kawashima S, Peltomäki T, Laine J, Rönning O (2002) Cephalometric evaluation of facial types in preschool children without sleep-related breathing disorder. Int J Pediatr Otorhinolaryngol 63:119–127CrossRefPubMedGoogle Scholar
  21. 21.
    Miles PG, Vig PS, Weyantet RJ, Rockette HE (1996) Cranialfacial structure and obstructive sleep apnea syndrome—a qualiative analysis and meta-analysis of the literature. Am J Orthod Dentofac Orthop 109:163–172CrossRefGoogle Scholar
  22. 22.
    Johannesson S (1968) Roentgenologic investigation of the nasopharyngeal tonsil in children of different ages. Acta Radiol Diagn 7:299–304Google Scholar
  23. 23.
    Fujioka M, Young LW, Girdany BR (1979) Radiographic evaluation of adenoidal size in children: adenoidal–nasopharyngeal ratio. Am J Roentgenol 133:401–404Google Scholar
  24. 24.
    Crepeau J, Patriquin HB, Poliquin JF, Tetreault L (1982) Radiographic evaluation of the symptom-producing adenoid. Otolaryngol Head Neck Surg 90:548–555PubMedGoogle Scholar
  25. 25.
    Enciso R, Nguyen M, Shigeta Y, Ogawa T, Clark GT (2010) Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and controls. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:285–293CrossRefPubMedGoogle Scholar
  26. 26.
    Shigeta Y, Ogawa T, Tomoko I, Clark GT, Enciso R (2010) Soft palate length and upper airway relationship in OSA and non-OSA subjects. Sleep Breath 14:353–358CrossRefPubMedGoogle Scholar
  27. 27.
    Aboudara C, Nielsen I, Huang JC, Maki K, Miller AJ, Hatcher D (2009) Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. Am J Orthod Dentofac Orthop 135:468–479CrossRefGoogle Scholar
  28. 28.
    Raanan A, Joseph MM, Andrew T, Soroosh M, Catherrine ET, Greg M, Richard JS, Allan IP (2001) Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 164:698–703Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.3rd dental centre, School and Hospital of StomatologyPeking UniversityBeijingChina
  2. 2.Department of Orthodontics, School and Hospital of StomatologyPeking UniversityBeijingChina

Personalised recommendations