Usefulness of cephalometry in sparing polysomnography of patients with suspected obstructive sleep apnea

Abstract

The aim of this investigation was to evaluate the contribution of cephalometry to a statistical model integrating clinical, physical, and oximetric variables, to reduce demands for polysomnographies. Two hundred and twenty-five consecutive patients that had been referred to the sleep clinic for suspected obstructive sleep apnea (OSA) were studied. The clinical assessment of all patients consisted of a sleep related questionnaire, the Epworth sleepiness scale, and a physical examination. In addition, they all underwent spirometry, cephalometry, and a full polysomnography. The clinical variables related with OSA were questions concerning witnessing of apneas by bed partners, intensity of snoring, a history of hypertension, and nocturia. A significant relation was also found with score on the Epworth scale, sex, age, body mass index, neck and waist circumferences, total number and frequency of oxygen desaturations, and the lowest oxygen saturation value. Significant cephalometric measurements were: the linear distance from gonion to gnathion, from the hyoid bone to the mandibular plane, and from the posterior nasal spine to the tip of the soft palate, and the thickness of the uvula as well. A statistical model was built to estimate a patient's probability of having OSA based on clinical variables, physical examination, pulse oximetry, and cephalometry. The validation of this model demonstrated a remarkable ability in reducing the number of polysomnographic studies. We conclude that cephalometry combined with clinical variables, physical examination, and nocturnal oximetry is useful in the diagnosis of OSA and enables the sparing of a considerable number of polysomnographies.

Cephalometric and anthropometric data of obstructive apnea in different age groups

“…9 Cephalometric X-rays have been used to investigate the topographic diagnosis of OSAS, 10,11 as they are useful in the assessment of upper airway morphology, and are too low in cost and readily available in most hospitals and radiology centers. 2,12,13 Certain anthropometric features are associated with the prevalence of OSAS. Thus, measurements of body mass index (BMI), neck circumference (NC), waist circumference (WC), and pelvic circumference (PC) have been analyzed by several authors as predictors of OSAS severity, 14---16 with obesity considered a predictive factor.…”

The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis

“…However, these 2-D studies have limited success in investigating the complex, threedimensional (3-D) upper airway. For this reason, 3-D CT has been used recently for full upper airway evaluation in patients with OSA [4][5][6][7][8]. In this study, we measured the upper airway structure more precisely for a short duration and calculated its volume with a 3-D multi-detector CT (3-D MDCT).…”

Cephalometric findings in facioscapulohumeral muscular dystrophy patients with obstructive sleep apneas

“…This suggests that clinical upper airway evaluation and cephalometric measures are poor predictors of OSAS in FSHD patients, as well as BMI, neck circumference, and daytime sleepiness [13]. Therefore, the observation that cephalometry, combined with clinical variables and physical examination, may help to diagnosis OSAS [20] is not applicable to FSHD patients. This is in accordance with the general principle that predictors of OSAS are not reliable in patients with neuromuscular disorders [7].…”

“…They have proved to be significantly related to the severity and the duration of OSAS [20,21], and it has been suggested that cephalometry combined with clinical variables and physical examination may help to diagnosis OSAS [20].…”

“…Moreover, cephalometric measures in OSAS patients provide relevant indications for the choice of the treatment [20][21][22]. Cephalometry and upper airway examination were performed in our FSHD patients with SDB and have been presented in a previous paper [13].…”