Craniofacial structure in patients with obstructive sleep apnoea

Background: Obstructive sleep apnoea (OSA) is characterised by at least five 10-s episodes of apnoea or markedly shallow breathing per 1 h of sleep, which can lead to severe, sometimes life-threatening complications. It is essential to determine the specific features of the affected patients’ craniofacial structure, thus enabling their allocation to risk groups. The aim of the study was to assess the craniofacial structure in OSA patients, comparing the findings with Hasund’s and Segner’s cephalometric normal values. In addition, the sagittal dimensions of the upper airways, measured at two levels, were compared to McNamara’s normal values. Materials and methods: The study covered 41 patients diagnosed polysomno­graphically with OSA. Lateral cephalograms with cephalometric analysis and the measurements of the upper and lower sagittal dimensions of the upper airways were taken for each patient. Results: The only feature of the patents’ facial skeleton that significantly diverged from the normal range was the SNB angle (p = 0.004). Other angles, i.e. SNA, ANB, NL/NSL, NL/ML and NSL/ML, were not significantly different from normal. The average upper cross-sectional area of the upper airways was 10.4 mm; in 97.6% patients, this measurement was below McNamara’s normal values. In the majority of patients (75.6%), the average lower sagittal dimension of the upper airways (10.4 mm) was also below the normal. Conclusions: Mandibular retrognathia, manifested by the reduced SNB angle, and the narrowed upper and lower sagittal dimensions of the upper airways can be considered one of OSA prognostic factors

Evaluation of upper airways depth among patients with skeletal Class I and III

Background: The aim of this study was to determine the value of upper andlower pharyngeal depth among patients with skeletal Class III malocclusion on lateral cephalograms, as well as to examine the relationship between SNA, SNB, and ANB angles, along with Wits appraisal and the cross-sectional value of upper airway space at the level of the soft palate and tongue base among patients withskeletal Class I and III.Materials and methods: The material consisted of lateral cephalograms taken from 80 patients living in the Lubelskie voivodeship. The study group consistedof cephalograms of 50 patients with skeletal Class III malocclusion (17 maleand 33 female), whereas the control group consisted of 30 roentgenograms of patients with Class I malocclusion with proper jaw to mandible relation (14 maleand 16 female). The study and the control group shared no statistically significant differences considering basic sociographic data such as gender (chi = 1.267, p = 0.26)and age (U = 727.5, p = 0.82). The upper and lower pharyngeal depths wereassessed with the use of McNamara’s method. Spearman’s rho test, Mann--Whitney’s U test, and chi test were used for statistical analysis.Results: Among both males and females the pharyngeal depths were greaterconsidering patients with skeletal Class III in comparison to patients with Class Imalocclusion (p < 0.001). Furthermore, it was determined that the lower as wellas the upper pharyngeal width is statistically significantly dependent on ANB and SNB angles and Wits appraisal (p < 0.001).Conclusions: Pharyngeal width at the level of the soft palate and tongue base depends on skeletal class, namely ANB angle and Wits appraisal; it increases with the increase of SNB angle (forward movement of the mandible). The SNA angle (position of the maxilla) does not influence the anterior-posterior nasopharyngeal dimension

The influence of upper airways diameter on the intensity of obstructive sleep apnea

Introduction and Objective. Obstructive sleep apnea (OSA) is characterized by at least 5 ten-second-long episodes of apnea or hypopnea, per hour of sleep. This disease may lead to severe, life-threatening complications. Therefore, risk analysis and its influence on disease intensity is crucial for proper implementation of preventive treatments. Objective. To determine the relation between the intensity of OSA expressed in Apnea-Hypopnea Index (AHI), and the anterior-posterior diameter of upper airways at the levels of soft palate and tongue base. Material and Method. Medical records of 41 patients with sleep apnea (AHI>4) diagnosed through polysomnographic examination obstructive were used for the study. The data consisted of: age and gender, polysomnographic examination results (AHI), lateral cephalogram with cephalomertic analysis, together with measurements of the upper and lower pharyngeal depth according to McNamara. Statistical analysis was carried out in accordance with Pearson’s r correlation coefficient test (Statistica 8.0 software package). Results. Analysis of the influence of upper airways diameter on the intensity of OSA showed that the value of upper Airways diameter at the tongue base level had no statistically significant impact on the value of AHI (p=0.795). However, a statistically significant impact of the value of upper airways diameter on the AHI value (p=0.008) at the soft palate level was observed. Patients with OSA have narrowed upper airways diameter. The value of AHI increases with the decrease of upper diameter and is not dependent on a lower diameter value. Patients with a decreased upper airways diameter should be informed about potential breathing disorders during sleep