Önder ÖZTÜRK, Süleyman Hakan TUNA, Hüseyin ALKIŞ, Mehmet HAS, Hüseyin Avni BALCIOĞLU, Hakan TÜRKKAHRAMAN, Ahmet AKKAYA

Comparison of Cephalometric Variables in Non-obese and Obese Patients with Obstructive Sleep Apnea

Objective: To compare the cephalometric variables of obese (body mass index (BMI) &ge;30) and non-obese (BMI&lt;30) Turkish male patients with obstructive sleep apnea syndrome (OSAS). Materials and Methods: OSAS diagnosed 85 patients who were obese [n=37; mean age (&plusmn;SE), 49.41&plusmn;1.54 year] and non-obese [n=48; mean age (&plusmn;SE) 46.92&plusmn;1.39 year] were included in the study. The cephalometric measurements and polysomnographic data of the patients were compared and a discriminatory analysis was performed. Results: The apnea-hypopnea index (AHI) was significantly higher in obese patients (p&lt;0.01). Bimaxillary protrusion was found in obese patients (p&lt;0.05). The non-obese patients with AHI &ge; 30 had an increased mandibular plane angle In the stepwise discriminant analysis done separately in obese and non-obese patients according to AHI; only the hyoid bone position was included in the model in obese patients and the estimated success of discrimination of AHI&#39;s level (&lt;30 and &ge;30) was 70.3%. Age, anterior face and posterior face height were included to the model in non-obese patients and the estimated success of discrimination was found as 79.2%. Conclusion: Craniofacial morphology has an effect on the severity of OSAS. If the craniofacial morphology tends toward a worsening of OSAS with obesity, the severity of the OSAS increases.

Keywords:

Cephalometry, obesity, obstructive sleep apnea syndrome, polysomnography,

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Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5. [CrossRef]
Tsai HH, Ho CY, Lee PL, Tan CT. Cephalometric analysis of non- obese snorers either with or without obstructive sleep apnea syn- drome. Angle Orthodon 2007;6:1054-61. [CrossRef]
Redline S, Tishler PV, Tosteson TD, Williamson J, Kump K, Brown- er I, et al. The familial aggregation of obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:682-7.
Sforza E, Bacon W, Weiss T, Thibault A, Petiau C, Krieger J. Upper airway collapsibility and cephalometric variables in pa- tients with obstructive sleep apnea. Am J Respir Crit Care Med 2000;161:347-52.
Battagel JM, Johal A. A cephalometric comparison of normal weight and obese subjects with obstructive sleep apnoea. Radi- ography 2000;6:283-92. [CrossRef]
Pracharktam N, Nelson S, Hans MG, Broadbent BH, Redline S, Rosen- berg C, et al. Cephalometric assessment in obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1996;109:410-9. [CrossRef]
Baik UB, Suzuki M, Ikeda K, Sugawara J, Mitani H. Relationship between cephalometric characteristics and obstructive sites in ob- structive sleep apnea syndrome. Angle Orthod 2002;72:124-34.
Ferguson KA, Ono T, Lowe AA, Ryan CF, Fleetham JA. The rela- tionship between obesity and craniofacial structure in obstructive sleep apnea. Chest 1995;108:375-81. [CrossRef]
Nelson S, Hans M. Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 1997;111:154-62. [CrossRef]
Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J 1999;13:403-10. [CrossRef]
Partinen M, Guilleminault C, Quera-Salva MA, Jamieson A. Ob- structive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest 1988;93:1199-205. [CrossRef]
Tsai HH, Ho CY, Lee PL, Tan CT. Sex differences in anthropomet- ric and cephalometric characteristics in the severity of obstruc- tive sleep apnea syndrome. Am J Orthod Dentofacial Orthop 2009;135:155-64. [CrossRef]
Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anat- omy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 1997;82:1319-26.
Yu X, Fujimoto K, Urushibata K, Matsuzawa Y, Kubo K. Cephalo- metric analysis in obese and nonobese patients with obstructive sleep apnea syndrome. Chest 2003;124:212-8. [CrossRef]
Li KK, Powell NB, Kushida C, Riley RW, Adornato B, Guilleminault C. A comparison of Asian and white patients with obstructive sleep apnea syndrome. Laryngoscope 1999;109:1937-40. [CrossRef]
World Health Organization. Obesity: preventing and managing the global epidemic. World Health Organization, Geneva. 1997.
Sleep-related breathing disorders in adults: recommendations forsyndrome definition and measurement techniques in clinical- research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89.
Revicki DA, Israel RG. Relationship between body mass indices and measures of body adiposity. Am J Public Health 1986;76:992-4. [CrossRef]
Ağargün MY, Çilli AS, Kara H, Bilici M, Telcioğlu M, Semiz ÜB ve ark. Epwort uykululuk ölçeği ‘nin geçerliği ve güvenirliği. Türk Psikiyatri Dergisi 1999;10:261-7.
Rechtschaffen A, Kales A. A manual of standardized terminol- ogy, techniques and scoring system for sleep stages of human subjects. In: Rechtschaffen A, Kales A, eds. National Institute of Health Publication, Washington DC: US Government Printing Office;1968.p.1-12.
Redline S, Tishler PV, Hans MG, Tosteson TD, Strohl KP, Spry K. Ra- cial differences in sleep-disordered breathing in African Americans and Caucasians. Am J Respir Crit Care Med 1997;155:186-92.
Berger G, Berger R, Oksenberg A. Progression of snoring and obstructive sleep apnoea: the role of increasing weight and time. Eur Respir J 2009;33:338-45. [CrossRef]
Yagi H, Nakata S, Tsuge H, Yasuma F, Noda A, Morinaga M, et al. Morphological examination of upper airway in obstructive sleep apnea. Auris Nasus Larynx 2009;36:444-9. [CrossRef]
Tsai WH, Remmers JE, Brant R, Flemons WW, Davies J, Macar- thur C. A decision rule for diagnostic testing in obstructive sleep apnea. Am J Respir Crit Care Med 2003;167:1427-32. [CrossRef]
Dahlqvist J, Dahlqvist A, Marklund M, Berggren D, Stenlund H, Franklin KA. Physical findings in the upper airways related to obstructive sleep apnea in men and women. Acta Otolaryngol 2007;127:623-30. [CrossRef]
Watanabe T, Isono S, Tanaka A, Tanzawa H, Nishino T. Contribu- tion of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep- disordered breathing. Am J Respir Crit Care Med 2002;165:260-5. [CrossRef]
Verin E, Tardif C, Buffet X, Marie JP, Lacoume Y, Andrieu-Guit- rancourt J, et al. Comparison between anatomy and resistance of upper airway in normal subjects, snorers and OSAS patients. Respir Physiol 2002;129:335-43. [CrossRef]
Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr. Cranio- facial structure and obstructive sleep apnea syndrome-a quali- tative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop 1996;109:163-72. [CrossRef]
Lee JJ, Ramirez SG, Will MJ. Gender and racial variations in ceph- alometric analysis. Otolaryngol Head Neck Surg 1997;117:326-9. [CrossRef]
Ishiguro K, Kobayashi T, Kitamura N, Saito C. Relationship be- tween severity of sleep-disordered breathing and craniofacial morphology in Japanese male patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:343-9. [CrossRef]
Sadeghianrizi A, Forsberg CM, Marcus C, Dahllöf G. Craniofacial development in obese adolescents. Eur J Orthod 2005;27:550-5.
Thilander B, Persson M, Adolfsson U. Roentgen-cephalometric standards for a Swedish population. A longitudinal study be- tween the ages of 5 and 31 years. Eur J Orthod 2005;27:370-89. [CrossRef]
Brander PE, Mortimore IL, Douglas NJ. Effect of obesity and erect/ supine posture on lateral cephalometry: relationship to sleep-disor- dered breathing. Eur Respir J 1999;13:398-402. [CrossRef]
Cistulli PA. Craniofacial abnormalities in obstructive sleep ap- noea: implications for treatment. Respirology 1996;1:167-74. [CrossRef]