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Craniofacial obesity in patients with obstructive sleep apnea

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Abstract

Introduction

Obstructive sleep apnea (OSA) and obesity are serious, widespread public health issues.

Objective

To localize and quantify geometric morphometric differences in facial soft tissue morphology in adults with and without OSA.

Materials and methods

Eighty adult Malays, consisting of 40 patients with OSA and 40 non-OSA controls, were studied. Both groups were evaluated by the attending physician and through ambulatory sleep studies. 3-D stereophotogrammetry was used to capture facial soft tissues of both groups. The 3-D mean OSA and control facial configurations were computed and subjected to principal components analysis (PCA) and finite-element morphometry (FEM).

Results

The body mass index was significantly greater for the OSA group (32.3 kg/m2 compared to 24.8 kg/m2, p < 0.001). The neck circumference was greater for the OSA group (42.7 cm compared to 37.1 cm, p < 0.001). Using PCA, significant differences were found in facial shape between the two groups using the first two principal components, which accounted for 50% of the total shape change (p < 0.05). Using FEM, these differences were localized in the bucco-submandibular regions of the face predominantly, indicating an increase in volume of 7–22% (p < 0.05) for the OSA group.

Conclusion

Craniofacial obesity in the bucco-submandibular regions is associated with OSA and may provide valuable screening information for the identification of patients with undiagnosed OSA.

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References

  1. Lam B, Ip MS, Tench E, Ryan CF (2005) Craniofacial profile in Asian and white subjects with obstructive sleep apnoea. Thorax 60:504–510 doi:10.1136/thx.2004.031591

    Article  CAS  PubMed  Google Scholar 

  2. Strohl KP, Redline S (1996) Recognition of obstructive sleep apnea. Am J Respir Crit Care Med 154:279–289

    CAS  PubMed  Google Scholar 

  3. Khan JH, Bazarbashi M, Stigsby B, Al-Ohaly Y (1995) Sleep apnea syndrome: a report of 20 Saudi patients. Ann Saudi Med 15:443–446

    CAS  PubMed  Google Scholar 

  4. Schlosshan D, Elliott MW (2004) Sleep. 3: clinical presentation and diagnosis of the obstructive sleep apnoea hypopnoea syndrome. Thorax 59:347–352 doi:10.1136/thx.2003.007179

    Article  CAS  PubMed  Google Scholar 

  5. Rowley JA, Aboussouan LS, Badr MS (2000) The use of clinical prediction formulas in the evaluation of obstructive sleep apnea. Sleep 23:929–938

    CAS  PubMed  Google Scholar 

  6. Kushida CA, Efron B, Guilleminault C (1997) A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med 127:581–587

    CAS  PubMed  Google Scholar 

  7. Hou HM, Hagg U, Sam K, Rabie AB, Wong RW, Lam B et al (2006) Dentofacial characteristics of Chinese obstructive sleep apnea patients in relation to obesity and severity. Angle Orthod 76:962–969 doi:10.2319/081005-273

    Article  PubMed  Google Scholar 

  8. 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 328:1230–1235 doi:10.1056/NEJM199304293281704

    Article  CAS  PubMed  Google Scholar 

  9. Kubota Y, Nakayama H, Takada T, Matsuyama N, Sakai K, Yoshizawa H et al (2005) Facial axis angle as a risk factor for obstructive sleep apnea. Intern Med 44:805–810 doi:10.2169/internalmedicine.44.805

    Article  PubMed  Google Scholar 

  10. Ono T, Lowe AA, Ferguson KA, Fleetham JA (1996) Associations among upper airway structure, body position, and obesity in skeletal Class I male patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 109:625–634 doi:10.1016/S0889-5406(96)70074-4

    Article  CAS  PubMed  Google Scholar 

  11. Singh GD, McNamara JA Jr, Lozanoff S (1997) Morphometry of the cranial base in subjects with Class III malocclusion. J Dent Res 76:694–703

    Article  CAS  PubMed  Google Scholar 

  12. Singh GD, Rivera-Robles J, de Jesus-Vinas J (2004) Longitudinal craniofacial growth patterns in patients with orofacial clefts: geometric morphometrics. Cleft Palate Craniofac J 41:136–143 doi:10.1597/02-166

    Article  CAS  PubMed  Google Scholar 

  13. Singh GD, Maldonado L, Thind BS (2004) Changes in the soft tissue facial profile following orthodontic extractions: a geometric morphometric study. Funct Orthod 22(40):34–38

    CAS  PubMed  Google Scholar 

  14. Singh GD, McNamara JA Jr, Lozanoff S (1999) Finite-element morphometry of soft tissues in prepubertal Korean and European-Americans with Class III malocclusions. Arch Oral Biol 44:429–436 doi:10.1016/S0003-9969(99)00012-6

    Article  CAS  PubMed  Google Scholar 

  15. Banabilh SM, Rajion ZA, Samsudin AR, Singh GD (2006) Facial soft tissue features assessed with finite element analysis. Int J Orthod Milwaukee 17:17–20

    PubMed  Google Scholar 

  16. Banabilh SM, Rajion ZA, Samsudin R, Singh GD (2006) Dental arch shape and size in Malay schoolchildren with Class II malocclusion. Aust Orthod J 22:99–103

    PubMed  Google Scholar 

  17. McAlarney ME, Chiu WK (1997) Comparison of numeric techniques in the analysis of cleft palate dental arch form change. Cleft Palate Craniofac J 34:281–291 doi:10.1597/1545-1569(1997)034<0281:CONTIT>2.3.CO;2

    Article  CAS  PubMed  Google Scholar 

  18. Pae EK, Lowe AA, Fleetham JA (1997) A thin-plate spline analysis of the face and tongue in obstructive sleep apnea patients. Clin Oral Investig 1:178–184 doi:10.1007/s007840050030

    Article  CAS  PubMed  Google Scholar 

  19. Banabilh SM, Suzina AH, Dinsuhaimi S, Singh GD (2007) Cranial base and airway morphology in adult Malays with obstructive sleep apnea. Aust Orthod J 23:89–95

    PubMed  Google Scholar 

  20. Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW et al (2003) Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 21:253–259 doi:10.1183/09031936.03.00298103

    Article  CAS  PubMed  Google Scholar 

  21. Skinner MA, Choudhury MS, Homan SD, Cowan JO, Wilkins GT, Taylor DR (2005) Accuracy of monitoring for sleep-related breathing disorders in the coronary care unit. Chest 127:66–71 doi:10.1378/chest.127.1.66

    Article  PubMed  Google Scholar 

  22. No authors listed (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689

    Google Scholar 

  23. Singh GD, Levy-Bercowski D, Yanez MA, Santiago PE (2007) Three-dimensional facial morphology following surgical repair of unilateral cleft lip and palate in patients after nasoalveolar molding. Orthod Craniofac Res 10:161–166 doi:10.1111/j.1601-6343.2007.00390.x

    Article  CAS  PubMed  Google Scholar 

  24. Singh GD, Abramson M (2008) Effect of an intra-oral nasal dilation appliance on 3-D nasal airway morphology in adults. Sleep Breath 12(1):69–75 doi:10.1007/s11325-007-0130-1

    Article  PubMed  Google Scholar 

  25. Singh GD, Olmos S (2007) Use of a sibilant phoneme registration protocol to prevent upper airway collapse in patients with TMD. Sleep Breath 11(4):209–216 doi:10.1007/s11325-007-0104-3

    Article  PubMed  Google Scholar 

  26. Singh GD (2008) Digital diagnostics: three-dimensional modelling. Br J Oral Maxillofac Surg 46(1):22–26 doi:10.1016/j.bjoms.2006.10.008

    Article  CAS  PubMed  Google Scholar 

  27. Singh GD, McNamara JA Jr, Lozanoff S (1997) Morphometry of the cranial base in subjects with Class III malocclusion. J Dent Res 76(2):694–703

    Article  CAS  PubMed  Google Scholar 

  28. Douglas TS (2004) Image processing for craniofacial landmark identification and measurement: a review of photogrammetry and cephalometry. Comput Med Imaging Graph 28:401–409 doi:10.1016/j.compmedimag.2004.06.002

    Article  PubMed  Google Scholar 

  29. Ferrario VF, Sforza C, Poggio CE, Serrao G (1996) Facial three-dimensional morphometry. Am J Orthod Dentofacial Orthop 109:86–93 doi:10.1016/S0889-5406(96)70167-1

    Article  CAS  PubMed  Google Scholar 

  30. Pack AI (2006) Advances in sleep-disordered breathing. Am J Respir Crit Care Med 173:7–15 doi:10.1164/rccm.200509-1478OE

    Article  PubMed  Google Scholar 

  31. Tsai WH, Remmers JE, Brant R, Flemons WW, Davies J, Macarthur C (2003) A decision rule for diagnostic testing in obstructive sleep apnea. Am J Respir Crit Care Med 15(10):1427–1432

    Article  Google Scholar 

  32. Ferrario VF, Dellavia C, Tartaglia GM, Turci M, Sforza C (2004) Soft tissue facial morphology in obese adolescents: a three-dimensional noninvasive assessment. Angle Orthod 74:37–42

    PubMed  Google Scholar 

  33. Dempsey JA, Skatrud JB, Jacques AJ, Ewanowski SJ, Woodson BT, Hanson PR et al (2002) Anatomic determinants of sleep-disordered breathing across the spectrum of clinical and nonclinical male subjects. Chest 122:840–851 doi:10.1378/chest.122.3.840

    Article  PubMed  Google Scholar 

  34. Lam B, Ooi CG, Peh WC, Lauder I, Tsang KW, Lam WK et al (2004) Computed tomographic evaluation of the role of craniofacial and upper airway morphology in obstructive sleep apnea in Chinese. Respir Med 98:301–307 doi:10.1016/j.rmed.2003.10.009

    Article  PubMed  Google Scholar 

  35. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C (2000) Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope 110:1689–1693 doi:10.1097/00005537-200010000-00022

    Article  CAS  PubMed  Google Scholar 

  36. Villaneuva AT, Buchanan PR, Yee BJ, Grunstein RR (2005) Ethnicity and obstructive sleep apnoea. Sleep Med Rev 9:419–436 doi:10.1016/j.smrv.2005.04.005

    Article  PubMed  Google Scholar 

  37. Watanabe T, Isono S, Tanaka A, Tanzawa H, Nishino T (2002) Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing. Am J Respir Crit Care Med 165:260–265

    PubMed  Google Scholar 

  38. Koenig JS, Thach BT (1988) Effects of mass loading on the upper airway. J Appl Physiol 64:2294–2299

    CAS  PubMed  Google Scholar 

  39. Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S et al (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109:1901–1907 doi:10.1097/00005537-199912000-00002

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Professor Ahmad Sukari, Head, Plastic and Reconstructive Unit, for the use of the 3dMD system and Dr. Hazama Mohamd, ENT specialist, for support in patient examination. This study was funded by a short term research grant (No. 304/PPSP/6131489), Universiti Sains Malaysia.

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Correspondence to G. D. Singh.

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Banabilh, S.M., Suzina, A.H., Dinsuhaimi, S. et al. Craniofacial obesity in patients with obstructive sleep apnea. Sleep Breath 13, 19–24 (2009). https://doi.org/10.1007/s11325-008-0211-9

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  • DOI: https://doi.org/10.1007/s11325-008-0211-9

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