Sleep and Breathing

, Volume 17, Issue 3, pp 911–923 | Cite as

CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review

  • Noura A. Alsufyani
  • Mohammed A. Q. Al-Saleh
  • Paul W. Major
Review

Abstract

Purpose

The aim of this study was to review studies using cone beam computed tomography (CBCT) to assess dimensional changes in the upper airway after appliance or surgical therapy in subjects with obstructive sleep apnoea and to correlate CBCT findings with treatment outcome.

Method

Several electronic databases were searched. Studies that met selection criteria were evaluated using a customized evaluation tool.

Results

Study parameters were met in seven articles. Fifty adults were assessed using CBCT 1.6–10 months after appliance therapy or maxillary mandibular advancement surgery with or without genial tubercle advancement. Airway parameters measured were linear, cross-sectional (CS) area, volume or airway function. In only two validated surgical case reports, airway volume increased by 6.5–9.7 cm3 (>80 %) and minimum CS area by 0.1–1.2 cm2 (21 and 269 %).

Conclusion

The available published studies show evidence of CBCT measured anatomic airway changes with surgery and dental appliance treatment for OSA. There is insufficient literature pertaining to the use of CBCT to assess treatment outcomes to reach a conclusion. High-quality evidence level studies, with statistically appropriate sample sizes and cross validated clinically, are needed to determine if CBCT airway dimensional changes are suitable for assessment of treatment outcome.

Keywords

Sleep apnoea syndromes Sleep apnoea obstructive Cone-beam computed tomography (CBCT) Treatment outcome 

References

  1. 1.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRefGoogle Scholar
  2. 2.
    Ioachimescu OC, Collop NA (2012) Sleep-disordered breathing. Neurol Clin 30:1095–1136PubMedCrossRefGoogle Scholar
  3. 3.
    Jackman AR, Biggs SN, Walter LM, Embuldeniya US, Davey MJ, Nixon GM, Anderson V, Trinder J, Horne RSC (2012) Sleep-disordered breathing in preschool children is associated with behavioral, but not cognitive, impairments. Sleep Med 13:621–631PubMedCrossRefGoogle Scholar
  4. 4.
    Conley RS (2011) Evidence for dental and dental specialty treatment of obstructive sleep apnoea. Part 1: The adult OSA patient and Part 2: The paediatric and adolescent patient. J Oral Rehabil 38:136–156PubMedCrossRefGoogle Scholar
  5. 5.
    Lumeng JC, Chervin RD (2008) Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5:242–252PubMedCrossRefGoogle Scholar
  6. 6.
    Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, Gozal D (2010) Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 182:676–683PubMedCrossRefGoogle Scholar
  7. 7.
    Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5:136–143PubMedCrossRefGoogle Scholar
  8. 8.
    Young T (2009) Rationale, design, and findings from the Wisconsin sleep Cohort study: toward understanding the total societal burden of sleep-disordered breathing. Sleep Med Clin 4:37–46PubMedCrossRefGoogle Scholar
  9. 9.
    Hoffstein V (2007) Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breathing 11:1–22PubMedCrossRefGoogle Scholar
  10. 10.
    Chen H, Lowe AA, Strauss AM, de Almeida FR, Ueda H, Fleetham JA, Wang B (2008) Dental changes evaluated with a 3D computer-assisted model analysis after long-term tongue retaining device wear in OSA patients. Sleep Breathing 12:169–178PubMedCrossRefGoogle Scholar
  11. 11.
    Strauss RA, Burgoyne CC (2008) Diagnostic imaging and sleep medicine. Dent Clin North Am 52:891–915PubMedCrossRefGoogle Scholar
  12. 12.
    Hatcher DC (2010) Cone beam computed tomography: craniofacial and airway analysis. Sleep Med Clin 5:59–70CrossRefGoogle Scholar
  13. 13.
    Kim JH, Guilleminault C (2011) The nasomaxillary complex, the mandible, and sleep-disordered breathing. Sleep Breathing 15:185–193PubMedCrossRefGoogle Scholar
  14. 14.
    Shi H, Scarfe W, Farman A (2006) Upper airway segmentation and dimensions estimation from cone-beam CT image datasets. Int J CARS 1:177–186CrossRefGoogle Scholar
  15. 15.
    Ogawa T, Enciso R, Shintaku WH, Clark GT (2007) Evaluation of cross-section airway configuration of obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:102–108PubMedCrossRefGoogle Scholar
  16. 16.
    Georgalas C, Garas G, Hadjihannas E, Oostra A (2010) Assessment of obstruction level and selection of patients for obstructive sleep apnoea surgery: an evidence-based approach. J Laryngol Otol 124:1–9PubMedCrossRefGoogle Scholar
  17. 17.
    Choi J, Hur Y, Lee J, Clark GT (2010) Effects of mandibular advancement on upper airway dimension and collapsibility in patients with obstructive sleep apnea using dynamic upper airway imaging during sleep. Oral Surg, Oral Med, Oral Pathol, Oral Radiol Endodontology 109:712–719CrossRefGoogle Scholar
  18. 18.
    McCrillis JM, Haskell J, Haskell BS, Brammer M, Chenin D, Scarfe WC, Farman AG (2009) Obstructive sleep apnea and the use of cone beam computed tomography in airway imaging: a review. Semin Orthod 15:63–69CrossRefGoogle Scholar
  19. 19.
    Aboudara CA, Hatcher D, Nielsen IL, Miller A (2003) A three-dimensional evaluation of the upper airway in adolescents. Orthod Craniofac Res 6(Suppl 1):173–175PubMedCrossRefGoogle Scholar
  20. 20.
    Hatcher DC (2012) Cone beam computed tomography: craniofacial and airway analysis. Dent Clin North Am 56:343–357PubMedCrossRefGoogle Scholar
  21. 21.
    Levendowski DJ, Morgan T, Montague J, Melzer V, Berka C, Westbrook PR (2008) Prevalence of probable obstructive sleep apnea risk and severity in a population of dental patients. Sleep Breathing 12:303–309PubMedCrossRefGoogle Scholar
  22. 22.
    Viswanathan M, Ansari M, Berkman N, Chang S, Hartling L, McPheeters L, Santaguida P, Shamliyan T, Singh K, Tsertsvadze A, Treadwell J (2012) Assessing the risk of bias of individual studies in systematic reviews of health care interventions. Agency for Healthcare Research and Quality Methods Guide for Comparative Effectiveness Reviews AHRQ publication no. 12-EHC047-EFGoogle Scholar
  23. 23.
    Huynh J, Kim D, McQuilling M (2009) Pharyngeal airflow analysis in obstructive sleep apnea patients pre- and post-maxillomandibular advancement surgery. J fluids Eng 131:091101–091111CrossRefGoogle Scholar
  24. 24.
    Schendel SA, Hatcher D (2010) Automated 3-dimensional airway analysis from cone-beam computed tomography data. J Oral Maxillofac Surg 68:696–701PubMedCrossRefGoogle Scholar
  25. 25.
    El AS, El H, Palomo JM, Baur DA (2011) A 3-dimensional airway analysis of an obstructive sleep apnea surgical correction with cone beam computed tomography. J Oral Maxillofac Surg 69:2424–2436PubMedCrossRefGoogle Scholar
  26. 26.
    Haskell JA, McCrillis J, Haskell BS, Scheetz JP, Scarfe WC, Farman AG (2009) Effects of mandibular advancement device (MAD) on airway dimensions assessed with cone-beam computed tomography. Semin Orthod 15:132–158CrossRefGoogle Scholar
  27. 27.
    Singh GD, Wendling S, Chandrashekhar R (2011) Midfacial development in adult obstructive sleep apnea. Dent Today 30:124–127PubMedGoogle Scholar
  28. 28.
    Abi-Ramia LBP, Carvalho FAR, Coscarelli CT, de Oliveira Almeida MA (2010) Increase in upper airway volume in patients with obstructive sleep apnea using a mandibular advancement device. Dental Press J Orthod 15:166–171CrossRefGoogle Scholar
  29. 29.
    Schendel S, Powell N, Jacobson R (2011) Maxillary, mandibular, and chin advancement: treatment planning based on airway anatomy in obstructive sleep apnea. J Oral Maxillofac Surg 69:663–676PubMedCrossRefGoogle Scholar
  30. 30.
    Sharma S (1999) Levels of evidence. Evid-Based Eye Care 1:5–6Google Scholar
  31. 31.
    Tsuiki S, Almeida FR, Bhalla PS, Lowe AA, Fleetham JA (2003) Supine-dependent changes in upper airway size in awake obstructive sleep apnea patients. Sleep Breathing 7:43–50PubMedCrossRefGoogle Scholar
  32. 32.
    Battagel JM, Johal A, Smith A, Kotecha B (2002) Postural variation in oropharyngeal dimensions in subjects with sleep disordered breathing: a cephalometric study. Eur J Orthod 24:263–276PubMedCrossRefGoogle Scholar
  33. 33.
    Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90:47–112PubMedCrossRefGoogle Scholar
  34. 34.
    Trudo FJ, Gefter WB, Welch KC, Gupta KB, Maislin G, Schwab RJ (1998) State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects. Am J Respir Crit Care Med 158:1259–1270PubMedCrossRefGoogle Scholar
  35. 35.
    Sittitavornwong S, Waite PD (2009) Imaging the upper airway in patients with sleep disordered breathing. Oral Maxillofac Surg Clin North Am 21:389–402PubMedCrossRefGoogle Scholar
  36. 36.
    Schwartz A, Patil S, Laffan A, Polotsky V, Schneider H, Smith P (2008) Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5:185–192PubMedCrossRefGoogle Scholar
  37. 37.
    Knutson KL, Zhao X, Mattingly M, Galli G, Cizza G (2012) Predictors of sleep-disordered breathing in obese adults who are chronic short sleepers. Sleep Med 13:484–489PubMedCrossRefGoogle Scholar
  38. 38.
    Whittle A, Finch SP, Mortimore I, MacKay T, Douglas N (1997) Use of home sleep studies for diagnosis of the sleep apnoea/hypopnoea syndrome. Thorax 52:1068–1073PubMedCrossRefGoogle Scholar
  39. 39.
    Flemons W, Littner M, Rowley J et al (2003) Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest 124:1543–1579PubMedCrossRefGoogle Scholar
  40. 40.
    Vos W, De Backer J, Devolder A, Vanderveken O, Verhulst S, Salgado R, Germonpre P, Partoens B, Wuyts F, Parizel P, De Backer W (2007) Correlation between severity of sleep apnea and upper airway morphology based on advanced anatomical and functional imaging. J Biomech 40:2207–2213PubMedCrossRefGoogle Scholar
  41. 41.
    Sung S, Jeong S, Yu Y, Hwang C, Pae E (2006) Customized three-dimensional computational fluid dynamics simulation of the upper airway of obstructive sleep apnea. Angle Orthod 76:791–799PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Noura A. Alsufyani
    • 1
    • 2
  • Mohammed A. Q. Al-Saleh
    • 1
  • Paul W. Major
    • 1
  1. 1.Department of Dentistry, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  2. 2.Department of DentistryEdmonton Clinic Health AcademyEdmontonCanada

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