Skip to main content
Top
Published in: Head & Face Medicine 1/2007

Open Access 01-12-2007 | Review

Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome: comparisons of cephalometric values

Authors: Antonino M Cuccia, Giuseppina Campisi, Rosangela Cannavale, Giuseppe Colella

Published in: Head & Face Medicine | Issue 1/2007

Login to get access

Abstract

Background

The aim of this paper was to determine the most common craniofacial changes in patients suffering Obstructive Sleep Apnea Syndrome (OSAS) with regards to the degree of obesity. Accordingly, cephalometric data reported in the literature was searched and analyzed.

Methods

After a careful analysis of the literature from 1990 to 2006, 5 papers with similar procedural criteria were selected. Inclusion criteria were: recruitment of Caucasian patients with an apnea-hypopnea index (AHI) >10 as grouped in non-obese (Body Mass Index – [BMI] < 30) vs. obese (BMI ≥ 30).

Results

A low position of the hyoid bone was present in both groups. In non-obese patients, an increased value of the ANB angle and a reduced dimension of the cranial base (S-N) were found to be the most common finding, whereas major skeletal divergence (ANS-PNS ^Go-Me) was evident among obese patients. No strict association was found between OSAS and length of the soft palate.

Conclusion

In both non-obese and obese OSAS patients, skeletal changes were often evident; with special emphasis of intermaxillary divergence in obese patients. Unexpectedly, in obese OSAS patients, alterations of oropharyngeal soft tissue were not always present and did not prevail.
Appendix
Available only for authorised users
Literature
1.
go back to reference American Academy of Sleep Medicine Task Force: Sleep-Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research. Sleep. 1999, 22: 667-689. American Academy of Sleep Medicine Task Force: Sleep-Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research. Sleep. 1999, 22: 667-689.
2.
go back to reference Guilleminault C: Sleep and breathing. Sleeping and waking disorders: indications and techniques. Edited by: Guilleminault C. 1982, MenloPark, CA: Addison-Wesley Publishing, 155-182. Guilleminault C: Sleep and breathing. Sleeping and waking disorders: indications and techniques. Edited by: Guilleminault C. 1982, MenloPark, CA: Addison-Wesley Publishing, 155-182.
3.
go back to reference Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistro P: A cause of excessive daytime sleepiness: the upper airway resistance syndrome. Chest. 1993, 104: 781-787. 10.1378/chest.104.3.781.CrossRefPubMed Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistro P: A cause of excessive daytime sleepiness: the upper airway resistance syndrome. Chest. 1993, 104: 781-787. 10.1378/chest.104.3.781.CrossRefPubMed
4.
go back to reference Tan WC, Koh TH: Evaluation of obstructive sleep apnoea in Singapore using computerised polygraphic monitoring. Ann Acad Med Singapore. 1991, 20 (2): 196-200.PubMed Tan WC, Koh TH: Evaluation of obstructive sleep apnoea in Singapore using computerised polygraphic monitoring. Ann Acad Med Singapore. 1991, 20 (2): 196-200.PubMed
5.
go back to reference Horner RL, Mohiaddin RH, Lowell DG, Shea SA, Burman FD, Longmore DB, Guz A: Sites and size of fat depositis around the pharynx in obese patients with obstructive sleep apnea and weight matched control. Eur Respir J. 1989, 2: 613-622.PubMed Horner RL, Mohiaddin RH, Lowell DG, Shea SA, Burman FD, Longmore DB, Guz A: Sites and size of fat depositis around the pharynx in obese patients with obstructive sleep apnea and weight matched control. Eur Respir J. 1989, 2: 613-622.PubMed
6.
go back to reference Bixler EO, Vgontzas AN, Lin HM: Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001, 163: 608-613.CrossRefPubMed Bixler EO, Vgontzas AN, Lin HM: Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001, 163: 608-613.CrossRefPubMed
7.
go back to reference Walker RP, Durazo-Arvizu R, Wachter B, Gopalsami C: Preoperative differences between male and female patients with sleep apnoea. Laryngoscope. 2001, 111: 1501-1505. 10.1097/00005537-200109000-00001.CrossRefPubMed Walker RP, Durazo-Arvizu R, Wachter B, Gopalsami C: Preoperative differences between male and female patients with sleep apnoea. Laryngoscope. 2001, 111: 1501-1505. 10.1097/00005537-200109000-00001.CrossRefPubMed
8.
go back to reference Marrone O, Bonsignore MR, Insalaco G, Salvaggio A: Patologia disventolatoria associata al sonno. Malattie dell'apparato respiratorio. 2006, McGraw-Hill.ed., Milano, 291-294. Marrone O, Bonsignore MR, Insalaco G, Salvaggio A: Patologia disventolatoria associata al sonno. Malattie dell'apparato respiratorio. 2006, McGraw-Hill.ed., Milano, 291-294.
9.
go back to reference Zuconi M, Ferroini Strambi L, Palazzi S: Craniofacial cephalometric evaluation in habitual snorers with and without obstuctive sleep apnea. Otolaryngfol Head Neck Surg. 1993, 109: 1007- Zuconi M, Ferroini Strambi L, Palazzi S: Craniofacial cephalometric evaluation in habitual snorers with and without obstuctive sleep apnea. Otolaryngfol Head Neck Surg. 1993, 109: 1007-
10.
go back to reference Andersson L, Brattstrom V: Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome. Int J Oral Maxillofac Surg. 1995, 20: 159-162. 10.1016/S0901-5027(05)80007-4.CrossRef Andersson L, Brattstrom V: Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome. Int J Oral Maxillofac Surg. 1995, 20: 159-162. 10.1016/S0901-5027(05)80007-4.CrossRef
11.
go back to reference Lowe A, Santamaria J, Fleetham J: Facial morphology and obstructive sleep apnea. Am J Orthod Dentofac Orthop. 1986, 90: 484-491. 10.1016/0889-5406(86)90108-3.CrossRef Lowe A, Santamaria J, Fleetham J: Facial morphology and obstructive sleep apnea. Am J Orthod Dentofac Orthop. 1986, 90: 484-491. 10.1016/0889-5406(86)90108-3.CrossRef
12.
go back to reference Fields HW, Warren DW, Black K, Phillips CL: Relationship between vertical dentofacial morphology and respiration in adolescents. Am J Orthod Dentofacial Orthop. 1991, 99: 147-154. 10.1016/0889-5406(91)70117-F.CrossRefPubMed Fields HW, Warren DW, Black K, Phillips CL: Relationship between vertical dentofacial morphology and respiration in adolescents. Am J Orthod Dentofacial Orthop. 1991, 99: 147-154. 10.1016/0889-5406(91)70117-F.CrossRefPubMed
13.
go back to reference Steinberg B, Fraser B: The cranial base in obstructive sleep apnea. J Oral Maxillofac Surg. 1995, 53: 1150-1154. 10.1016/0278-2391(95)90621-5.CrossRefPubMed Steinberg B, Fraser B: The cranial base in obstructive sleep apnea. J Oral Maxillofac Surg. 1995, 53: 1150-1154. 10.1016/0278-2391(95)90621-5.CrossRefPubMed
14.
go back to reference Ozbek MM, Miyamoto K, Lowe AA, Fleetham JA: Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults. Eur J Orthod. 1998, 20: 133-143. 10.1093/ejo/20.2.133.CrossRefPubMed Ozbek MM, Miyamoto K, Lowe AA, Fleetham JA: Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults. Eur J Orthod. 1998, 20: 133-143. 10.1093/ejo/20.2.133.CrossRefPubMed
15.
go back to reference Wong ML, Sandham A, Ang PK, Wong DC, Tan WC, Huggare J: Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: an inter-ethnic comparison. Eur J Orthod. 2005, 27: 91-97. 10.1093/ejo/cjh077.CrossRefPubMed Wong ML, Sandham A, Ang PK, Wong DC, Tan WC, Huggare J: Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: an inter-ethnic comparison. Eur J Orthod. 2005, 27: 91-97. 10.1093/ejo/cjh077.CrossRefPubMed
16.
go back to reference Ingman T, Nieminen T, Hurmerinta K: Cephalometric Comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions. Eur J Orthod. 2004, 26: 321-326. 10.1093/ejo/26.3.321.CrossRefPubMed Ingman T, Nieminen T, Hurmerinta K: Cephalometric Comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions. Eur J Orthod. 2004, 26: 321-326. 10.1093/ejo/26.3.321.CrossRefPubMed
17.
go back to reference Baik UB, Suzuki M, Ikeda K, Sugawara J, Mitani H: Relationship between cephalometric characteristics and obstructive sites in obstructive sleep apnea Sindrome. Angle Orthodontist. 2002, 72: 124-134.PubMed Baik UB, Suzuki M, Ikeda K, Sugawara J, Mitani H: Relationship between cephalometric characteristics and obstructive sites in obstructive sleep apnea Sindrome. Angle Orthodontist. 2002, 72: 124-134.PubMed
18.
go back to reference Lowe AA, Fleetham JA, Adachi S, Ryan CF: Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod. 1995, 107 (6): 589-595.CrossRef Lowe AA, Fleetham JA, Adachi S, Ryan CF: Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod. 1995, 107 (6): 589-595.CrossRef
19.
go back to reference Partinem M, Guilleminault C, Quera-Salva MA, Jamieson A: Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest. 1988, 93: 1199-1205. 10.1378/chest.93.6.1199.CrossRef Partinem M, Guilleminault C, Quera-Salva MA, Jamieson A: Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest. 1988, 93: 1199-1205. 10.1378/chest.93.6.1199.CrossRef
20.
go back to reference NIH Technology Assessment Conference panel: National Institute of Health Technology Assessment Conference: Methods for Voluntary Weight Loss and Control. Ann Intern Med. 1993, 119: 764-77.CrossRef NIH Technology Assessment Conference panel: National Institute of Health Technology Assessment Conference: Methods for Voluntary Weight Loss and Control. Ann Intern Med. 1993, 119: 764-77.CrossRef
21.
go back to reference Tangugsorn V, Krogstad O, Espeland L, Lyberg T: Obstructive sleep apnoea: multiple comparisons og cephalometric variables of obese and non obese patients. J Cranio-Maxillofacial Surgery. 2000, 28: 204-212. 10.1054/jcms.2000.0147.CrossRef Tangugsorn V, Krogstad O, Espeland L, Lyberg T: Obstructive sleep apnoea: multiple comparisons og cephalometric variables of obese and non obese patients. J Cranio-Maxillofacial Surgery. 2000, 28: 204-212. 10.1054/jcms.2000.0147.CrossRef
22.
go back to reference Glantz SA: Primer of Biostatistics. 2002, 77-80. 5 Glantz SA: Primer of Biostatistics. 2002, 77-80. 5
23.
go back to reference Sforza E, Bacon W, Weiss T, Thibault A, Petiau C, Krieger J: Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2000, 161 (2 Pt 1): 347-352.CrossRefPubMed Sforza E, Bacon W, Weiss T, Thibault A, Petiau C, Krieger J: Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2000, 161 (2 Pt 1): 347-352.CrossRefPubMed
24.
go back to reference Pae EK, Ferguson KA: Cephalometric characteristics of nonobese patients with severe OSA. Angle Orthod. 1999, 69 (5): 408-412.PubMed Pae EK, Ferguson KA: Cephalometric characteristics of nonobese patients with severe OSA. Angle Orthod. 1999, 69 (5): 408-412.PubMed
25.
go back to reference Paoli JR, Lauwers F, Lacassagne L, Tiberge M, Dodart L, Boutault F: Craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: cephalometric study in 85 patients. British J Oral Maxillofacial Surg. 2001, 39: 40-45. 10.1054/bjom.2000.0551.CrossRef Paoli JR, Lauwers F, Lacassagne L, Tiberge M, Dodart L, Boutault F: Craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: cephalometric study in 85 patients. British J Oral Maxillofacial Surg. 2001, 39: 40-45. 10.1054/bjom.2000.0551.CrossRef
26.
go back to reference Iked N, Hazime N, Dekeister C, Folia M, Tiberge M, Paoli JR: Comparaison des caractéristiques céphalométriques de patients ronfleurs et apnéiques en fonction du degré d'obésité. A propos de 162 cas. Rev Stom: Chir Maxillofac. 2001, 102: 305-311. Iked N, Hazime N, Dekeister C, Folia M, Tiberge M, Paoli JR: Comparaison des caractéristiques céphalométriques de patients ronfleurs et apnéiques en fonction du degré d'obésité. A propos de 162 cas. Rev Stom: Chir Maxillofac. 2001, 102: 305-311.
27.
28.
go back to reference Ferguson KA, Ono T, Lowe AA, Ryan F, Fleetham JA: The relationship between obesity and craniofacial structure in obstructive sleep apnoea. Chest. 1995, 108: 375-381.CrossRefPubMed Ferguson KA, Ono T, Lowe AA, Ryan F, Fleetham JA: The relationship between obesity and craniofacial structure in obstructive sleep apnoea. Chest. 1995, 108: 375-381.CrossRefPubMed
29.
go back to reference Nelson S, Hans M: Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorer.s. Chest. 1997, 111: 154-162.CrossRefPubMed Nelson S, Hans M: Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorer.s. Chest. 1997, 111: 154-162.CrossRefPubMed
30.
go back to reference Solow B, Sandham A: Cranio-cervical posture: a factor in the development and function of the dentofacial structures. Eur J Orthod. 2002, 24 (5): 447-56. 10.1093/ejo/24.5.447.CrossRefPubMed Solow B, Sandham A: Cranio-cervical posture: a factor in the development and function of the dentofacial structures. Eur J Orthod. 2002, 24 (5): 447-56. 10.1093/ejo/24.5.447.CrossRefPubMed
31.
go back to reference Solow B, Skov S, Ovesen J, Norup PW, Wildschiotdz G: Airway dimensions and head posture in obstructive sleep apnoea. Eur J Orthod. 1996, 18 (6): 571-579. 10.1093/ejo/18.6.571.CrossRefPubMed Solow B, Skov S, Ovesen J, Norup PW, Wildschiotdz G: Airway dimensions and head posture in obstructive sleep apnoea. Eur J Orthod. 1996, 18 (6): 571-579. 10.1093/ejo/18.6.571.CrossRefPubMed
32.
go back to reference Huggare J, Laine-Alava MT: Nasorespiratory function and head posture. Am J Orthodontics and Dentofacial Orthopedics. 1997, 112: 507-511. 10.1016/S0889-5406(97)70078-7.CrossRef Huggare J, Laine-Alava MT: Nasorespiratory function and head posture. Am J Orthodontics and Dentofacial Orthopedics. 1997, 112: 507-511. 10.1016/S0889-5406(97)70078-7.CrossRef
33.
go back to reference Winnberg A, Pancherz H, Westesson PL: Head posture and hyomandibular function in man: a synchronized electromyographic and videofluorographic study of the open-close clench-cycle. Am J Orthod Dentofacial Orthop. 1988, 94: 393-404. 10.1016/0889-5406(88)90128-X.CrossRefPubMed Winnberg A, Pancherz H, Westesson PL: Head posture and hyomandibular function in man: a synchronized electromyographic and videofluorographic study of the open-close clench-cycle. Am J Orthod Dentofacial Orthop. 1988, 94: 393-404. 10.1016/0889-5406(88)90128-X.CrossRefPubMed
34.
go back to reference Strollo PJ, Rogers RM: Obstructive sleep apnoea. New England Journal of Medicine. 1996, 334: 99-104. 10.1056/NEJM199601113340207.CrossRefPubMed Strollo PJ, Rogers RM: Obstructive sleep apnoea. New England Journal of Medicine. 1996, 334: 99-104. 10.1056/NEJM199601113340207.CrossRefPubMed
35.
go back to reference 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: 1230-1235. 10.1056/NEJM199304293281704.CrossRefPubMed 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: 1230-1235. 10.1056/NEJM199304293281704.CrossRefPubMed
Metadata
Title
Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome: comparisons of cephalometric values
Authors
Antonino M Cuccia
Giuseppina Campisi
Rosangela Cannavale
Giuseppe Colella
Publication date
01-12-2007
Publisher
BioMed Central
Published in
Head & Face Medicine / Issue 1/2007
Electronic ISSN: 1746-160X
DOI
https://doi.org/10.1186/1746-160X-3-41

Other articles of this Issue 1/2007

Head & Face Medicine 1/2007 Go to the issue