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Year 2025, Volume: 28 Issue: 1, 79 - 87, 28.03.2025

Elif Çelik , Fatih Çelik , Edhem Ünver , Erdal Karavaş , Samih Diyarbakır

https://doi.org/10.7126/cumudj.1592867

Abstract

References

  • 1. Silva ASD, Rabelo FAW, Thuler E, Kayamori F, Bianchini EMG. Obstructive Sleep Apnea: characterization of the obstructive site and type of collapse. Codas. 2022;16;34(5):e20210208.
  • 2. Sung CM, Tan SN, Shin MH, et al. The Site of Airway Collapse in Sleep Apnea, Its Associations with Disease Severity and Obesity, and Implications for Mechanical Interventions. Am J Respir Crit Care Med. 2021;204(1):103-106.
  • 3. Mannarino MR, Di Filippo F, Pirro M. Obstructive sleep apnea syndrome. Eur J Intern Med. 2012;23(7):586-593.
  • 4. Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311-1322.
  • 5. Gottlieb DJ, Yenokyan G, Newman AB, et al. A Prospective Study of Obstructive Sleep Apnea and Incident Coronary Heart Disease and Heart Failure: The Sleep Heart Health Study. Circulation. 2010;122(4):352-360.
  • 6. Lipton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev. 2003;7(1):61-80.
  • 7. Carberry JC, Amatoury J, Eckert DJ. Personalized Management Approach for OSA. Chest. 2018;153(3):744-755.
  • 8. Hudgel DW. The role of upper airway anatomy and physiology in obstructive sleep apnea. Clin Chest Med. 1992;13(3):383-398.
  • 9. Vavougios GD, Natsios G, Pastaka C, Zarogiannis SG, Gourgoulianis KI. Phenotypes of comorbidity in OSAS patients: combining categorical principal component analysis with cluster analysis. J Sleep Res. 2016;25(1):31-38.
  • 10. Song L, Li H, Wang J, et al. Educational attainment could be a protective factor against obstructive sleep apnea: a study based on Mendelian randomization. J Thorac Dis. 2022;14(1):210-215.
  • 11. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291(16):2013-2016.
  • 12. Chen H, Aarab G, de Ruiter MHT, de Lange J, Lobbezoo F, van der Stelt PF. Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review. Sleep Med. 2016;21:19-27.
  • 13. Fleetham JA. Upper airway imaging in relation to obstructive sleep apnea. Clin Chest Med. 1992;13(3):399-416.
  • 14. Zhang W, si L yi. Obstructive sleep apnea syndrome (OSAS) and hypertension: Pathogenic mechanisms and possible therapeutic approaches. Ups J Med Sci. 2012;117(4):370-382.
  • 15. Aihara K, Oga T, Harada Y, et al. Analysis of anatomical and functional determinants of obstructive sleep apnea. Sleep Breath. 2012;16(2):473-481.
  • 16. Schwab RJ, Kim C, Bagchi S, et al. Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents. Am J Respir Crit Care Med. 2015;191(11):1295-1309.
  • 17. Ernst G, Mariani J, Blanco M, Finn B, Salvado A, Borsini E. Increase in the frequency of obstructive sleep apnea in elderly people. Sleep Sci Sao Paulo Braz. 2019;12(3):222-226.
  • 18. Leppänen T, Töyräs J, Mervaala E, Penzel T, Kulkas A. Severity of individual obstruction events increases with age in patients with obstructive sleep apnea. Sleep Med. 2017;37:32-37.
  • 19. Iannella G, Vicini C, Colizza A, et al. Aging effect on sleepiness and apneas severity in patients with obstructive sleep apnea syndrome: a meta-analysis study. Eur Arch Otorhinolaryngol. 2019;276(12):3549-3556.
  • 20. Bozkurt MK, Oy A, Aydin D, et al. Gender differences in polysomnographic findings in Turkish patients with obstructive sleep apnea syndrome. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol - Head Neck Surg. 2008;265(7):821-824.
  • 21. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
  • 22. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81.
  • 23. Zhou X, Zhou B, Li Z, et al. Gender differences of clinical and polysomnographic findings with obstructive sleep apnea syndrome. Sci Rep. 2021;11(1):5938.
  • 24. Geer JH, Hilbert J. Gender Issues in Obstructive Sleep Apnea. Yale J Biol Med. 2021;94(3):487-496.
  • 25. Lee JJ, Sundar KM. Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome. Lung. 2021;199(2):87-101.
  • 26. Cojocaru C, Cojocaru E, Pohaci-Antonesei LS, Pohaci-Antonesei CA, Dumitrache-Rujinski S. Sleep apnea syndrome associated with gonadal hormone imbalance (Review). Biomed Rep. 2023;19(6):101.
  • 27. Shigeta Y, Ogawa T, Tomoko I, Clark GT, Enciso R. Soft palate length and upper airway relationship in OSA and non-OSA subjects. Tex Dent J. 2013;130(3):203-211.
  • 28. Pollis M, Lobbezoo F, Aarab G, Ferrari M, Marchese-Ragona R, Manfredini D. Correlation between Apnea Severity and Sagittal Cephalometric Features in a Population of Patients with Polysomnographically Diagnosed Obstructive Sleep Apnea. J Clin Med. 2022;11(15):4572.
  • 29. Ryu HH, Kim CH, Cheon SM, et al. The usefulness of cephalometric measurement as a diagnostic tool for obstructive sleep apnea syndrome: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(1):20-31.
  • 30. Neelapu BC, Kharbanda OP, Sardana HK, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Med Rev. 2017;31:79-90.
  • 31. Tanellari O, Toti C, Baruti Papa E, et al. The Link between Obstructive Sleep Apnea Syndrome and Cephalometric Assessment of Upper Airways and Hyoid Bone Position. Medicina (Mex). 2022;58(9):1213.
  • 32. Jo JH, Park JW, Jang JH, Chung JW. Hyoid bone position as an indicator of severe obstructive sleep apnea. BMC Pulm Med. 2022;22(1):349.
  • 33. Hei RY, Qin J, Li SH. Predictive value of hyoid cephalometrics for retroglossal obstruction in patients with obstructive sleep apnoea hypopnea syndrome. J Laryngol Otol. 2019;133(2):119-124.
  • 34. Kohno A, Kitamura Y, Kato S, et al. Displacement of the hyoid bone by muscle paralysis and lung volume increase: the effects of obesity and obstructive sleep apnea. Sleep. 2019;42(1):zsy198.
  • 35. Kurbanova A, Szabo BT, Aksoy S, et al. Comparison of hyoid bone morphology between obstructive sleep apnea patients and healthy individuals. Int J Clin Pract. 2021;75(12):e15004.
  • 36. Soares MM, Romano FL, Dias FV da S, et al. Association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone. Braz J Otorhinolaryngol. 2022;88(3):331-336.
  • 37. 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.
  • 38. Chaves Junior CM, Adriano Araújo VM, Estanislau IMG, et al. A retrospective study of the influence of obesity on polysomnography and cephalometric parameters in males with obstructive sleep apnea. Cranio J Craniomandib Pract. Published online September 12, 2021:1-7.

Cephalometric Examination of Soft Palate, Hyoid and Upper Airway Anatomy in Obstructive Sleep Apnea Syndrome Patients

Year 2025, Volume: 28 Issue: 1, 79 - 87, 28.03.2025

Elif Çelik , Fatih Çelik , Edhem Ünver , Erdal Karavaş , Samih Diyarbakır

https://doi.org/10.7126/cumudj.1592867

Abstract

Objectives: In this study, soft palate dimensions, hyoid bone position in relation to the mandibular plane and C3 vertebrae, and upper airway widths were measured on lateral cephalograms of patients diagnosed with simple snoring and obstructive sleep apnea syndrome of different severities by polysomnography. It was aimed to investigate whether increased apnea severity is associated with these anatomical formations which are important in the dental clinic.
Materials and Methods: Our study was designed as a retrospective data analysis of 182 patients, 78 females and 104 males. In our study, patients were divided into four groups: patients with simple snoring with an Apnea-Hipopnea index (AHI) value below 5, patients with mild OSAS with an AHI value of 5-15, patients with moderate OSAS with an AHI value of 15-30 and patients with severe OSAS with an AHI value above 30. Measurements obtained from lateral cephalograms were compared between these groups.
Results: Statistically significant narrowing was observed in all other groups compared to the control group in oropharyngeal width values in upper airway measurements (P<0.05). The distance between the hyoid and mandibular plane was significantly lower in the control group than in the severe OSAS group (P=0.001). A statistically significant elongation of the soft palate was also observed in patients with OSAS compared to the control group (P<0.05).
Conclusions: Our findings support that the position of the hyoid bone is important in the diagnosis of OSAS. Furthermore, a significant correlation was found between soft palate length and OSAS. These results suggest that surgical techniques such as maxillary advancement or mandibular advancement, or both, to increase airway width may be effective in the treatment of OSAS.

Keywords

Cephalometry Hyoid bone Obstructive Sleep Apnea Syndrome Soft Palate Upper Airway Anatomy

References

  • 1. Silva ASD, Rabelo FAW, Thuler E, Kayamori F, Bianchini EMG. Obstructive Sleep Apnea: characterization of the obstructive site and type of collapse. Codas. 2022;16;34(5):e20210208.
  • 2. Sung CM, Tan SN, Shin MH, et al. The Site of Airway Collapse in Sleep Apnea, Its Associations with Disease Severity and Obesity, and Implications for Mechanical Interventions. Am J Respir Crit Care Med. 2021;204(1):103-106.
  • 3. Mannarino MR, Di Filippo F, Pirro M. Obstructive sleep apnea syndrome. Eur J Intern Med. 2012;23(7):586-593.
  • 4. Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311-1322.
  • 5. Gottlieb DJ, Yenokyan G, Newman AB, et al. A Prospective Study of Obstructive Sleep Apnea and Incident Coronary Heart Disease and Heart Failure: The Sleep Heart Health Study. Circulation. 2010;122(4):352-360.
  • 6. Lipton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev. 2003;7(1):61-80.
  • 7. Carberry JC, Amatoury J, Eckert DJ. Personalized Management Approach for OSA. Chest. 2018;153(3):744-755.
  • 8. Hudgel DW. The role of upper airway anatomy and physiology in obstructive sleep apnea. Clin Chest Med. 1992;13(3):383-398.
  • 9. Vavougios GD, Natsios G, Pastaka C, Zarogiannis SG, Gourgoulianis KI. Phenotypes of comorbidity in OSAS patients: combining categorical principal component analysis with cluster analysis. J Sleep Res. 2016;25(1):31-38.
  • 10. Song L, Li H, Wang J, et al. Educational attainment could be a protective factor against obstructive sleep apnea: a study based on Mendelian randomization. J Thorac Dis. 2022;14(1):210-215.
  • 11. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291(16):2013-2016.
  • 12. Chen H, Aarab G, de Ruiter MHT, de Lange J, Lobbezoo F, van der Stelt PF. Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review. Sleep Med. 2016;21:19-27.
  • 13. Fleetham JA. Upper airway imaging in relation to obstructive sleep apnea. Clin Chest Med. 1992;13(3):399-416.
  • 14. Zhang W, si L yi. Obstructive sleep apnea syndrome (OSAS) and hypertension: Pathogenic mechanisms and possible therapeutic approaches. Ups J Med Sci. 2012;117(4):370-382.
  • 15. Aihara K, Oga T, Harada Y, et al. Analysis of anatomical and functional determinants of obstructive sleep apnea. Sleep Breath. 2012;16(2):473-481.
  • 16. Schwab RJ, Kim C, Bagchi S, et al. Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents. Am J Respir Crit Care Med. 2015;191(11):1295-1309.
  • 17. Ernst G, Mariani J, Blanco M, Finn B, Salvado A, Borsini E. Increase in the frequency of obstructive sleep apnea in elderly people. Sleep Sci Sao Paulo Braz. 2019;12(3):222-226.
  • 18. Leppänen T, Töyräs J, Mervaala E, Penzel T, Kulkas A. Severity of individual obstruction events increases with age in patients with obstructive sleep apnea. Sleep Med. 2017;37:32-37.
  • 19. Iannella G, Vicini C, Colizza A, et al. Aging effect on sleepiness and apneas severity in patients with obstructive sleep apnea syndrome: a meta-analysis study. Eur Arch Otorhinolaryngol. 2019;276(12):3549-3556.
  • 20. Bozkurt MK, Oy A, Aydin D, et al. Gender differences in polysomnographic findings in Turkish patients with obstructive sleep apnea syndrome. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol - Head Neck Surg. 2008;265(7):821-824.
  • 21. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
  • 22. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81.
  • 23. Zhou X, Zhou B, Li Z, et al. Gender differences of clinical and polysomnographic findings with obstructive sleep apnea syndrome. Sci Rep. 2021;11(1):5938.
  • 24. Geer JH, Hilbert J. Gender Issues in Obstructive Sleep Apnea. Yale J Biol Med. 2021;94(3):487-496.
  • 25. Lee JJ, Sundar KM. Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome. Lung. 2021;199(2):87-101.
  • 26. Cojocaru C, Cojocaru E, Pohaci-Antonesei LS, Pohaci-Antonesei CA, Dumitrache-Rujinski S. Sleep apnea syndrome associated with gonadal hormone imbalance (Review). Biomed Rep. 2023;19(6):101.
  • 27. Shigeta Y, Ogawa T, Tomoko I, Clark GT, Enciso R. Soft palate length and upper airway relationship in OSA and non-OSA subjects. Tex Dent J. 2013;130(3):203-211.
  • 28. Pollis M, Lobbezoo F, Aarab G, Ferrari M, Marchese-Ragona R, Manfredini D. Correlation between Apnea Severity and Sagittal Cephalometric Features in a Population of Patients with Polysomnographically Diagnosed Obstructive Sleep Apnea. J Clin Med. 2022;11(15):4572.
  • 29. Ryu HH, Kim CH, Cheon SM, et al. The usefulness of cephalometric measurement as a diagnostic tool for obstructive sleep apnea syndrome: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(1):20-31.
  • 30. Neelapu BC, Kharbanda OP, Sardana HK, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Med Rev. 2017;31:79-90.
  • 31. Tanellari O, Toti C, Baruti Papa E, et al. The Link between Obstructive Sleep Apnea Syndrome and Cephalometric Assessment of Upper Airways and Hyoid Bone Position. Medicina (Mex). 2022;58(9):1213.
  • 32. Jo JH, Park JW, Jang JH, Chung JW. Hyoid bone position as an indicator of severe obstructive sleep apnea. BMC Pulm Med. 2022;22(1):349.
  • 33. Hei RY, Qin J, Li SH. Predictive value of hyoid cephalometrics for retroglossal obstruction in patients with obstructive sleep apnoea hypopnea syndrome. J Laryngol Otol. 2019;133(2):119-124.
  • 34. Kohno A, Kitamura Y, Kato S, et al. Displacement of the hyoid bone by muscle paralysis and lung volume increase: the effects of obesity and obstructive sleep apnea. Sleep. 2019;42(1):zsy198.
  • 35. Kurbanova A, Szabo BT, Aksoy S, et al. Comparison of hyoid bone morphology between obstructive sleep apnea patients and healthy individuals. Int J Clin Pract. 2021;75(12):e15004.
  • 36. Soares MM, Romano FL, Dias FV da S, et al. Association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone. Braz J Otorhinolaryngol. 2022;88(3):331-336.
  • 37. 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.
  • 38. Chaves Junior CM, Adriano Araújo VM, Estanislau IMG, et al. A retrospective study of the influence of obesity on polysomnography and cephalometric parameters in males with obstructive sleep apnea. Cranio J Craniomandib Pract. Published online September 12, 2021:1-7.
There are 38 citations in total.

Details

Primary Language English
Subjects Oral and Maxillofacial Surgery, Oral and Maxillofacial Radiology
Journal Section Original Research Articles
Authors

Elif Çelik 0000-0002-5059-9432

Fatih Çelik 0000-0001-6806-8480

Edhem Ünver 0000-0002-0322-8102

Erdal Karavaş 0000-0001-6649-3256

Samih Diyarbakır 0000-0001-6755-7741

Publication Date March 28, 2025
Submission Date November 28, 2024
Acceptance Date December 30, 2024
Published in Issue Year 2025Volume: 28 Issue: 1

Cite

EndNote Çelik E, Çelik F, Ünver E, Karavaş E, Diyarbakır S (March 1, 2025) Cephalometric Examination of Soft Palate, Hyoid and Upper Airway Anatomy in Obstructive Sleep Apnea Syndrome Patients. Cumhuriyet Dental Journal 28 1 79–87.
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