Skip to main content

Advertisement

SpringerLink
Log in

The Interaction Between Craniofacial Computed Tomographic Dimensional Parameters and BMI in Obstructive Sleep Apnea

  • Original Article
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Introduction

The impact of the dimensional parameters of the pharyngeal bony frame by its length, width and the position of the hyoid upon the severity of obstructive sleep apnea syndrome (OSAS) has not been investigated in depth. Interactions of those parameters with body mass index (BMI) and their overall reciprocal effect on OSAS severity have also not been established.

Materials and Methods

This retrospective cross-sectional study was conducted on 108 male OSAS patients followed in OSAS outpatient clinics between November 2014 and October 2015. They all underwent a polysomnography test, and an apnea–hypopnea index (AHI) was calculated. They also underwent an upper airway computerized tomographic scan in which three craniofacial parameters were evaluated: inter-pterygoid distance (IPD), hard palate-to-hyoid (HP-H) distance, and gnathion plane-to-hyoid (GP-H) distance.

Results

A longer pharynx and an inferiorly placed hyoid bone correlated with the AHI (r = 0.33, p = 0.001 and r = 0.226, p = 0.03, respectively). GP-H correlated with body mass index (BMI) (r = 0.3243, p < 0.001), while HP-H and IPD did not. We found an interaction between BMI and HP-H, but none between GP-H and BMI. IPD did not correlate with OSAS severity, but it correlates with the age of the OSAS patients (r = 0.235, p = 0.015).

Conclusion

Pharynx length and hyoid position have significant effects upon OSAS severity, and they interact differently with BMI in terms of those effects. Hard palate width increases with age but has no correlation with OSAS severity.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  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(17):1230–1235

    Article  CAS  Google Scholar 

  2. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053

    Article  PubMed  Google Scholar 

  3. Xu JX, Cai W, Sun JF, Liao WJ, Liu Y, Xiao JR et al (2015) Serum advanced glycation end products are associated with insulin resistance in male nondiabetic patients with obstructive sleep apnea. Sleep Breath 19(3):827–833

    Article  PubMed  Google Scholar 

  4. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ et al (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31(8):1071–1078

    PubMed  PubMed Central  Google Scholar 

  5. Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J (1999) The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 340(11):847–851

    Article  CAS  PubMed  Google Scholar 

  6. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90(1):47–112

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Young T, Peppard PE, Taheri S (2005) Excess weight and sleep-disordered breathing. J Appl Physiol 99(4):1592–1599

    Article  PubMed  Google Scholar 

  8. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK (2010) Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest 137(3):711–719

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284(23):3015–3021

    Article  CAS  PubMed  Google Scholar 

  10. Shelton KE, Woodson H, Gay S, Suratt PM (1993) Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis 148(2):462–466

    Article  CAS  PubMed  Google Scholar 

  11. Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R et al (2003) Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 168(5):522–530

    Article  PubMed  Google Scholar 

  12. Kobayashi H, Kato I, Terabayashi T (1988) Anthropometric relevance on sublabial transseptal transsphenoidal hypophysectomy in the Asiatic type of skull. ORL J Otorhinolaryngol Relat Spec 50(5):340–344

    Article  CAS  PubMed  Google Scholar 

  13. Patel Manmohan (2012) Study of the distance between the free edges of Medial Pterygoid Plates in the Skulls of Central Indian Population. Int J Biol Med Res 3(2):1520–1524

    Google Scholar 

  14. Mendelson B, Wong C-H (2012) Changes in the Facial Skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthet Plast Surg 36(4):753–760. https://doi.org/10.1007/s00266-012-9904-3

    Article  Google Scholar 

  15. Chi L, Comyn FL, Mitra N, Reilly MP, Wan F, Maislin G et al (2011) Identification of craniofacial risk factors for obstructive sleep apnoea using three-dimensional MRI. Eur Respir J 38(2):348–358

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Buchanan A, Cohen R, Looney S, Kalathingal S, De Rossi S (2016) Cone-beam CT analysis of patients with obstructive sleep apnea compared to normal controls. Imaging Sci Dent 46(1):9–16

    Article  PubMed  PubMed Central  Google Scholar 

  17. Malhotra A, Huang Y, Fogel RB, Pillar G, Edwards JK, Kikinis R et al (2002) The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med 166(10):1388–1395

    Article  PubMed  Google Scholar 

  18. Genta PR, Schorr F, Eckert DJ, Gebrim E, Kayamori F, Moriya HT et al (2014) Upper airway collapsibility is associated with obesity and hyoid position. Sleep 37(10):1673–1678

    Article  PubMed  PubMed Central  Google Scholar 

  19. Barkdull GC, Kohl CA, Patel M, Davidson TM (2008) Computed tomography imaging of patients with obstructive sleep apnea. Laryngoscope 118(8):1486–1492

    Article  PubMed  Google Scholar 

  20. Pae EK, Lowe AA, Fleetham JA (1997) A role of pharyngeal length in obstructive sleep apnea patients. Am J Orthod Dentofacial Orthop 111(1):12–17

    Article  CAS  PubMed  Google Scholar 

  21. 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(6):653–664

    Article  CAS  PubMed  Google Scholar 

  22. Bucchieri A, Mastrangelo C, Stella R, Poladas EG (2004) Cephalometric evaluation of hyoid bone position in patients with obstructive sleep apnea. Minerva Stomatol 53(1–2):33–39

    CAS  PubMed  Google Scholar 

  23. Lowe AA, Ozbek MM, Miyamoto K, Pae EK, Fleetham JA (1997) Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis. Angle Orthod 67(2):143–153

    CAS  PubMed  Google Scholar 

  24. Ferguson KA, Ono T, Lowe AA, Ryan CF, Fleetham JA (1995) The relationship between obesity and craniofacial structure in obstructive sleep apnea. Chest 108(2):375–381

    Article  CAS  PubMed  Google Scholar 

  25. Tangugsorn V, Krogstad O, Espeland L, Lyberg T (2000) Obstructive sleep apnoea: multiple comparisons of cephalometric variables of obese and non-obese patients. J Craniomaxillofac Surg 28(4):204–212

    Article  CAS  PubMed  Google Scholar 

  26. Nelson S, Hans M (1997) Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 111(1):154–162

    Article  CAS  PubMed  Google Scholar 

  27. Sforza E, Bacon W, Weiss T, Thibault A, Petiau C, Krieger J (2000) Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med 161(2 Pt 1):347–352

    Article  CAS  PubMed  Google Scholar 

  28. Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H et al (2014) Tongue fat and its relationship to obstructive sleep apnea. Sleep 37(10):1639–1648

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A (1998) Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 157(1):144–148

    Article  CAS  PubMed  Google Scholar 

  30. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ et al (2002) Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 162(8):893–900

    Article  PubMed  Google Scholar 

  31. Young T, Skatrud J, Peppard PE (2004) Risk factors for obstructive sleep apnea in adults. JAMA 291(16):2013–2016

    Article  CAS  PubMed  Google Scholar 

  32. Mayer P, Pepin JL, Bettega G, Veale D, Ferretti G, Deschaux C et al (1996) Relationship between body mass index, age and upper airway measurements in snorers and sleep apnoea patients. Eur Respir J 9(9):1801–1809

    Article  CAS  PubMed  Google Scholar 

  33. Deng X, Gu W, Li Y, Liu M, Li Y, Gao X (2014) Age-group-specific associations between the severity of obstructive sleep apnea and relevant risk factors in male and female patients. PLoS ONE 9(9):e107380

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Ayas NT, Pittman S, MacDonald M, White DP (2003) Assessment of a wrist-worn device in the detection of obstructive sleep apnea. Sleep Med 4(5):435–442

    Article  PubMed  Google Scholar 

  35. Pittman SD, Ayas NT, MacDonald MM, Malhotra A, Fogel RB, White DP (2004) Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: in-laboratory and ambulatory validation. Sleep 27(5):923–933

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pittman SD, Pillar G, Berry RB, Malhotra A, MacDonald MM, White DP (2006) Follow-up assessment of CPAP efficacy in patients with obstructive sleep apnea using an ambulatory device based on peripheral arterial tonometry. Sleep Breath 10(3):123–131

    Article  PubMed  Google Scholar 

  37. White DP (2008) Monitoring peripheral arterial tone (PAT) to diagnose sleep apnea in the home. J Clin Sleep Med 4(1):73

    PubMed  PubMed Central  Google Scholar 

  38. Zou D, Grote L, Peker Y, Lindblad U, Hedner J (2006) Validation a portable monitoring device for sleep apnea diagnosis in a population based cohort using synchronized home polysomnography. Sleep 29(3):367–374

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was performed in fulfillment of Daniel Ben Ner’s M.D. thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University, Israel. We kindly ask to acknowledge Esther Eshkol for her editorial support.

Author information

Author notes

  1. Daniel Ben Ner and Narin Nard Carmel-Neiderman have been equally contributed to this work.

Authors and Affiliations

  1. Department of Otolaryngology Head & Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv, 6423906, Israel

    Daniel Ben Ner, Narin Nard Carmel-Neiderman, Dan M. Fliss & Eyal Rosenzweig

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Daniel Ben Ner, Narin Nard Carmel-Neiderman, Dan M. Fliss, Noa Haas & Eyal Rosenzweig

  3. School of Mathematical Science, Tel Aviv University, Tel Aviv, Israel

    Noa Haas

Authors
  1. Daniel Ben Ner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Narin Nard Carmel-Neiderman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dan M. Fliss
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noa Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eyal Rosenzweig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eyal Rosenzweig.

Ethics declarations

Conflict of interest

There are no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ben Ner, D., Carmel-Neiderman, N.N., Fliss, D.M. et al. The Interaction Between Craniofacial Computed Tomographic Dimensional Parameters and BMI in Obstructive Sleep Apnea. J. Maxillofac. Oral Surg. 18, 299–306 (2019). https://doi.org/10.1007/s12663-018-1140-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-018-1140-1

Keywords

Search

Navigation