Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis

Fagundes, Nathália Carolina Fernandes; Gianoni-Capenakas, Silvia; Heo, Giseon; Flores‐Mir, Carlos

doi:10.5664/jcsm.9904

Cited by 22 publications

(14 citation statements)

References 44 publications

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“…This inconsistency significantly impaired the scientific possibilities because important literature can be missed due to not matching terms. Maybe this is one of the reasons why previous systematic reviews on this topic (Agha & Johal, 2017; Armalaite & Lopatiene, 2016; Fagundes et al, 2022; Flores‐Mir et al, 2013; Katyal, Pamula, et al, 2013; Miles et al, 1996; Neelapu et al, 2017) did not have a comparable number of publications included in the meta‐analysis for the assessment of relevant items, even if the inclusion and exclusion criteria were less strict in some cases compared to the present systematic review.…”

Section: Discussionmentioning

confidence: 98%

Craniofacial risk factors for obstructive sleep apnea—systematic review and meta‐analysis

Finke,

Drews,

Engel

et al. 2023

Journal of Sleep Research

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SummaryObstructive sleep apnea (OSA) is caused by temporary partial or complete constriction of the upper airway during sleep which leads to reduced blood oxygen and cardiovascular risks. Main symptoms vary between adults and children leading to misdiagnosis or delayed patient identification. To improve early diagnosis, lateral cephalograms can provide craniofacial measurements associated with a higher risk of OSA. In order to identify the most relevant craniofacial measurements, a systematic literature review with meta‐analysis was conducted combining the terms ‘orthodontic*’, ‘craniofacial’, ‘cephalometr*’, ‘cephalogram’, ‘OSA*’, ‘UARS’, ‘SDB’, ‘sleep disordered breathing’, ‘sleep apnea’ and ‘sleep apnoea’. Of 3016 publications, 19 were included in the systematic review and meta‐analysis, 15 with adult patients and four with children. A total of 16 measurements (six angles, 10 distances) were compared, nine showed a possible influence in patients with OSA compared to controls: NSBa angle (−0.28°), ANB angle (+0.33°), ML‐NSL angle (+0.34°), Me‐Go‐Ar angle (+0.33°), SN distance (−0.70 mm), N–ANS distance (−0.36 mm), MP–H distance (+1.18 mm), uvula length (+1.07 mm) and thickness (+0.96 mm). Posterior airway measurements were not sufficiently described or comparably measured to be statistically analysed. There is some evidence for altered craniofacial anatomy in patients with OSA compared to controls. Lateral cephalograms should be screened for these aspects routinely to improve early diagnosis of OSA and craniofacial orthopaedics should complement the interdisciplinary treatment plan for young patients with OSA.

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Section: Discussionmentioning

confidence: 98%

Craniofacial risk factors for obstructive sleep apnea—systematic review and meta‐analysis

Finke,

Drews,

Engel

et al. 2023

Journal of Sleep Research

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show abstract

“…The contribution of maxillofacial factors to OSA onset in children remains controversial. 12 Deng and Gao showed that children in the OSA group presented with a retrusive mandible, deficient chin, and a long lower face. 27 Furthermore, Di Francesco et al found that dolichocephalic facial pattern (r=−0.33), mandibular plane (r=0.48), and facial depth (r=−0.33) were correlated with OSA among boys.…”

Section: Discussionmentioning

confidence: 99%

“…In the profile view, there were controversial viewpoints on cephalometric angles of children (maxillary depth angle, mandibular depth angle, ANB), which was explained by the heterogeneity between the studies and could be regarded as having marginal clinical significance. 11 , 12 A study of 382 children aged 6–8 years reported an association between a more convex facial profile and higher SDB risk. 33 We found that a greater ANB and convex facial profiles were observed only in the PS group after adjusting for BMI (z-score), and profile angles were insufficient to distinguish between the controls and patients with OSA.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 11 However, due to the heterogeneity of methodology, evidence has not confirmed an association between OSA and craniofacial features. 12 …”

Section: Introductionmentioning

confidence: 99%

“…10,11 However, due to the heterogeneity of methodology, evidence has not confirmed an association between OSA and craniofacial features. 12 Lateral cephalometry, computed tomography (CT), and magnetic resonance imaging (MRI) are used for craniofacial evaluations. These methods have rarely been applied to community or pediatric sleep clinics because of their expense, time-consuming nature, and/or radiation exposure.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics Combined with Craniofacial Photographic Analysis in Children with Obstructive Sleep Apnea

Wang¹,

Xu²,

Zhao³

et al. 2023

NSS

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Purpose Distinguishing obstructive sleep apnea (OSA) in a high-risk population remains challenging. This study aimed to investigate clinical features to identify children with OSA combined with craniofacial photographic analysis. Methods One hundred and forty-five children (30 controls, 62 with primary snoring, and 53 with OSA) were included. Differences in general demographic characteristics and surface facial morphology among the groups were compared. Risk factors and prediction models for determining the presence of OSA (obstructive sleep apnea-hypopnea index>1) were developed using logistic regression analysis. Results The BMI (z-score), tonsil hypertrophy, and lower face width (adjusted age, gender, and BMI z-score) were showed significantly different in children with OSA compared with primary snoring and controls (adjusted p<0.05). The screening model based on clinical features and photography measurements correctly classified 79.3% of the children with 64.2% sensitivity and 89.1% specificity. The area under the curve of the model was 81.0 (95% CI, 73.5–98.4%). Conclusion A screening model based on clinical features and photography measurements would be helpful in clinical decision-making for children with highly suspected OSA if polysomnography remains inaccessible in resource-stretched healthcare systems.

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An Evidence Base of Treatment Outcome for Class II Malocclusion

Papageorgiou

2024

Orthodontic Management of Class II Malocclusion

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Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis

Cited by 22 publications

References 44 publications

Craniofacial risk factors for obstructive sleep apnea—systematic review and meta‐analysis

Craniofacial risk factors for obstructive sleep apnea—systematic review and meta‐analysis

Clinical Characteristics Combined with Craniofacial Photographic Analysis in Children with Obstructive Sleep Apnea

An Evidence Base of Treatment Outcome for Class II Malocclusion

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