Correlation of Lateral Cephalogram and Flexible Laryngoscopy with Sleep Study in Obstructive Sleep Apnea

Abstract

Objective. To study the correlation between lateral cephalogram, flexible laryngoscopy, and sleep study in patients diagnosed with obstructive sleep apnea (OSA). Background. Screening tools should be devised for predicting OSA which could be performed on an outpatient basis. With this aim we studied the skeletal and soft tissue characteristics of proven OSA patients. Methods. A prospective study was performed in patients diagnosed with obstructive sleep apnea by sleep study. They were evaluated clinically and subjected to lateral cephalometry and nasopharyngolaryngoscopy. The findings were matched to see if they corresponded to AHI of sleep study in severity. An attempt was made to see whether the data predicted the patients who would benefit from oral appliance or surgery as the definitive treatment in indicated cases. Results. A retropalatal collapse seen on endoscopy could be equated to the distance from mandibular plane to hyoid (MP-H) of lateral cephalometry and both corresponded to severity of AHI. At the retroglossal region, there was a significant correlation with MP-H, length of the soft palate, and AHI. Conclusion. There is significant correlation of lateral cephalogram and awake flexible nasopharyngolaryngoscopy with AHI in OSA. In unison they form an excellent screening tool for snorers.

A Comparative Analysis of Cephalometric data and Drug induced sleep endoscopy in OSA patients – a Sri Lankan perspective

“…Normative values of Cephalometry were derived from previously published data in Caucasian population 18,19 ( Table 1). A visual analogue scale of 0 to 10 was used to subjectively assess the patient satisfaction pre-and post-treatment, where 0 was denoting on complains and 10 being extremely troublesome OSA.Epworth Sleepiness score 20 was calculated for all participants prior to treatment and after 6 months of intervention(surgery or CPAP).…”

“…This posed a challenge, as the only comparable data available are published in Caucasian and Chinese populations 14,23,24 . The only study in the South Asian population comparing cephalometry and Awake flexible nasal endoscopy by A. Narayan (2015) also had compared the data referencing literature in Caucasian population 18 .…”

Airway Findings of Nasolaryngoscopy and Cephalometry Associated with Obstructive Sleep Apnea

“…12 Fiberoptic nasolaryngoscopy is a simple and routine examination, performed mostly by the otolaryngologist, in order to identify the area of collapse in patients with OSA in threedimensional assessment of airway. [13][14][15] This collapse can occur at different levels such as the nasopharynx, hypopharynx, and larynx. The hypertrophy of palatine adenoids and tonsils, and alterations in the morphology of the retropalatine area, are the anatomic areas most associated with the presence and severity of OSA.…”

“…16 Lateral cephalometry is another diagnostic tool used for identifying airway obstructions associated with OSA. Cephalometric measures that have shown greater association with the diagnosis of OSA are: mandibular retrognathism, mandibular micrognathism, increased ANB angle, lower position of the hyoid bone, and decrease in upper and lower pharynx space, 13,17 but craniofacial features associated with OSA are diverse in different populations and ethnic groups. 18,19 Identification of obstruction areas using cephalometry in conjunction with other methods such as endoscopic studies in patients with OSA is important for diagnosis, prognosis, and treatment.…”

“…Barbosa et al 23 and Souki et al 24 showed a high degree of correlation between the cephalometric measurements and nasopharynx space measured by fiberoptic nasolaryngoscopy in children, but there are few studies about this correlation in adults. 13 The objectives of the current study were to determine the correlation between the findings of the fiberoptic nasolaryngoscopy and lateral radiographies, and to evaluate the…”