Facial morphology and obstructive sleep apnea

Abstract

Objective: This study aimed at assessing the relationship between facial morphological patterns (I, II, III, Long Face and Short Face) as well as facial types (brachyfacial, mesofacial and dolichofacial) and obstructive sleep apnea (OSA) in patients attending a center specialized in sleep disorders. Methods: Frontal, lateral and smile photographs of 252 patients (157 men and 95 women), randomly selected from a polysomnography clinic, with mean age of 40.62 years, were evaluated. In order to obtain diagnosis of facial morphology, the sample was sent to three professors of Orthodontics trained to classify patients' face according to five patterns, as follows: 1) Pattern I; 2) Pattern II; 3) Pattern III; 4) Long facial pattern; 5) Short facial pattern. Intraexaminer agreement was assessed by means of Kappa index. The professors ranked patients' facial type based on a facial index that considers the proportion between facial width and height. Results: The multiple linear regression model evinced that, when compared to Pattern I, Pattern II had the apnea and hypopnea index (AHI) worsened in 6.98 episodes. However, when Pattern II was compared to Pattern III patients, the index for the latter was 11.45 episodes lower. As for the facial type, brachyfacial patients had a mean AHI of 22.34, while dolichofacial patients had a significantly statistical lower index of 10.52. Conclusion: Patients' facial morphology influences OSA. Pattern II and brachyfacial patients had greater AHI, while Pattern III patients showed a lower index.

Facial phenotype in obstructive sleep apnea–hypopnea syndrome: a systematic review and meta‐analysis

“…Whiles Capistrano et al . () did not find any significant difference in facial type between OSAHS and non‐OSAHS subjects, there was a high prevalence of class II pattern in the OSAHS group. The latter finding is in agreement with Banabilh et al .…”

“…As the majority of included studies were judged to be of a moderate level of evidence, comparison of their findings using forest plots was justified. However, two of the included studies (Capistrano et al, 2015;Zonato et al, 2005) had a low and unreliable level of evidence, and were not consequently included in the meta-analysis.…”

“…Meta-analysis was performed using RevMan (version 5.1; Nordic Cochrane Centre, Cochrane Collaboration, 2011). Three of the included studies (Cakirer et al, 2001;Capistrano et al, 2015;Zonato et al, 2005) were not subjected to meta-analysis as they were of low quality evidence or lacked shared outcomes. The common outcomes for the remaining five included studies all regarded as a moderate quality of evidence were analysed using forest plots.…”

“…A high inter-examiner agreement (IRR = 0.88) was observed, with six out of eight included studies (Banabilh et al, 2009(Banabilh et al, , 2010Cakirer et al, 2001;Lam et al, 2005; Lee al., 2009a;Perri et al, 2014) judged to be of moderate quality, and the remaining two studies (Capistrano et al, 2015;Zonato et al, 2005) rated as low-level evidence (Tables 1 and S4). From the quality assessment, the majority of the included studies had an adequate definition of cases (OSAHS subjects) and controls; however, there was potential for selection bias (hospital-based).…”

“…In the current systematic review, we included four different surface facial assessments to explore morphological features in subjects with OSAHS: (i) 2D photogrammetry of the head and neck region (Capistrano et al, 2015;Lam et al, 2005;Lee et al, 2009a); (ii) 3D stereophotogrammetry of the face (Banabilh et al, 2009); (iii) direct surface measurements of the face (Cakirer et al, 2001;Perri et al, 2014); and (iv) physical examination of the face looking for the sagittal displacement of the mandible or facial profile (Banabilh et al, 2010;Zonato et al, 2005).…”