Differences in three-dimensional upper airway anatomy between Asian and European patients with obstructive sleep apnea

Abstract

Study Objectives This study evaluated differences in upper airway, soft tissues and craniofacial structures between Asians from China and Europeans from Iceland with OSA using three-dimensional magnetic resonance imaging (MRI). Methods Airway sizes, soft tissue volumes, and craniofacial dimensions were compared between Icelandic (N = 108) and Chinese (N = 57) patients with oxygen desaturation index (ODI) ≥ 10 events/h matched for age, gender, and ODI. Mixed effects models adjusting for height or BMI and residual differences in age and ODI were utilized. Results In our matched sample, compared to Icelandic OSA patients, Chinese patients had smaller BMI (p < 0.0001) and neck circumference (p = 0.011). In covariate adjusted analyses, Chinese showed smaller retropalatal airway size (p ≤ 0.002), and smaller combined soft tissues, tongue, fat pads, and pterygoid (all p ≤ 0.0001), but male Chinese demonstrated a larger soft palate volume (p ≤ 0.001). For craniofacial dimensions, Chinese demonstrated bigger ANB angle (p ≤ 0.0196), differently shaped mandibles, including shorter corpus length (p < 0.0001) but longer ramus length (p < 0.0001), and a wider (p < 0.0001) and shallower (p ≤ 0.0001) maxilla. Conclusions Compared to Icelandic patients of similar age, gender and ODI, Chinese patients had smaller retropalatal airway and combined soft tissue, but bigger soft palate volume (in males), and differently shaped mandible and maxilla with more bony restrictions. Results support an ethnic difference in upper airway anatomy related to OSA, which may inform targeted therapies.

Use and Performance of the STOP-Bang Questionnaire for Obstructive Sleep Apnea Screening Across Geographic Regions

“…Chinese individuals have a smaller, narrower retropalatal airway and soft tissues with greater susceptibility to pharyngeal collapse. 72 Differences are found between ethnic groups, such that Asian populations have more craniofacial restriction, 73 while European groups have larger upper airway soft tissues (ie, larger tongue and parapharyngeal fat pads) 73 with smaller airway dimensions. 14 Similarly, North American and South American populations also showed increased neck circumference, which is associated with greater odds of a higher Mallampati class, indicative of oropharyngeal crowding, while Asian groups do not.…”

Dynamic tongue area measurements in ultrasound images for adults with obstructive sleep apnea

“…It may further decrease airway caliber as it may occupy the UA space; hence there may be a possible association with the development of OSA. Interactions between a limited maxilla‐mandibular size (the container) and a large tongue size (the content) were said to be an indicator of having severe OSA (Riley, Powell, & Guilleminault, 1990), particularly in Asian patients with OSA (Sutherland, Lee, & Cistulli, 2012; Xu et al, 2019). A disproportion between tongue volume and craniofacial framework will cause increased tissue pressure around the UA and lead to the closure of the pharyngeal airway (Watanabe, Isono, Tanaka, Tanzawa, & Nishino, 2002).…”

Respiratory and sleep characteristics based on frequency distribution of craniofacial skeletal patterns in Korean adult patients with obstructive sleep apnea

“…African Americans exhibited higher obesity and enlarged upper airway soft tissues, while Caucasians showed evidence of both skeletal and soft tissue abnormalities [16,17]. A more recent study summarized that craniofacial restriction may be more important in OSA risk in Chinese than in Caucasian patients [15], and Chinese patients appeared to present more severe OSA than Caucasians when the body mass index (BMI) was matched at the same level [18,19]. As for Koreans, we had previously identified and characterized three clusters of OSA patients by integrating craniofacial features into sleep characteristics [20].…”