Association between facial morphology, airway, PSG and PSQ in OSA-children

INTRODUCTION: Cephalometric soft tissue findings have shown correlation with pharyngeal width. Facial photographic analysis of patients with Obstructive Sleep Apnea (OSA) shows an increase in width and flatness of the midface. However, three-dimensional facial soft tissue morphology of children with OSA has not been studied. OBJECTIVE: The objective of the current study was to evaluate the association between facial morphology, upper airway volume, Polysomnography (PSG), and Pediatric Sleep Questionnaire (PSQ) findings in children with OSA versus controls. MATERIAL AND METHODS: The sample included de-identified pre-treatment Cone-beam Computed Tomography images, PSG and PSQ results of 36 children (mean age 6.8 ± 2.8) from one pediatric dental practice. Three-dimensional facial soft tissue landmarks were digitized using Mimics v.20 software. Upper airway volume was segmented into right nasal cavity (RNC), left nasal cavity (LNC), nasopharynx (NP), oropharynx (OP), and hypopharynx (HP). Apnea Hypopnea Index (AHI), Respiratory Disturbance Index (RDI) scores and Pediatric sleep questionnaire (PSQ) values were correlated with soft tissue measurements (a modified Farkas anthropometric analysis) and upper airway volumes using Pearson’s correlation. Student’s T-test was used to evaluate the difference between facial soft tissue measurements of children with obstructive sleep apnea (OSA) versus the control group. RESULTS: Experimental versus control: Polysomnography findings: Apnea/Hipopnea Index and Respiratory Disturbance Index were statistically higher in obstructive sleep apnea children compared to controls (p=<.0001, 0.0001), and lowest oxygen percentage SpO2 was significantly lower (p=0.006). Airway volume findings: Right nasal cavity was statistically larger in obstructive sleep apnea children compared to controls (p=0.04). Soft tissue findings: Exocanthus right to midsagittal plane, Exocanthus right and Exocanthus left, and Soft tissue orbitale right to midsagittal plane were smaller in obstructive sleep apnea children compared to controls (p=0.01, 0.02, 0.03). Experimental group results: Transverse. Nose: Bialar distance was positively correlated to right nasal cavity and nasopharynx, and negatively correlated to hypopharynx, Apnea/Hipopnea Index, and Respiratory Disturbance Index. Lips: Chelion Right and Left, and Crista Philtri Right and Left were positively correlated to NasoPharynx. Anteroposterior. Most of nose and lips measurements were positively correlated to Right Nasal Cavity and negatively correlated to Respiratory Disturbance Index and low oxygen percentage SpO2. Vertical. Nose measurements were positively correlated to NasoPharynx. Lips measurements were positively correlated to NasoPharynx and OroPharynx and negatively correlated to low oxygen percentage SpO2. Control group result: Transverse. Nose: Nostril Base Right to midsagittal was positively correlated to NasoPharynx and average oxygen percentage SpO2 and negatively correlated to Respiratory Disturbance Index. ProNasale to Nostril Base Right and Nostril Base Left was negatively correlate to Pediatric Sleep Questionnaire. Lips: Crista Philtri Right to midsagittal and Chelion Right to midsagittal plane were positively correlated to NasoPharynx and average oxygen percentage SpO2. Anteroposterior. Nose measurements were positively correlated to Right Nasal Cavity, NasoPharynx, OroPharynx, and HypoPharynx and negatively correlated to Pediatric Sleep Questionnaire. Lips measurements were positively correlated to Right Nasal Cavity, NasoPharynx. And OroPharynx. Vertical. Most nose and lips measurements were positively correlated to Right Nasal Cavity, NasoPharynx, OroPharynx, and HypoPharynx, and negatively correlated to Apnea/Hypopnea Index and Respiratory Disturbance Index. CONCLUSION: It can be concluded that for the experimental group wider faces at the level of the eyes, nose and lips indicated increased upper airway volumes, decreased Polysomnography, and Pediatric Sleep Questionnaire values. Moreover, more forward position of the nose and lips in relation to the coronal plane were linked to increased nasal airway volume and decreased Polysomnography values. Finally, long-faced individuals displayed higher volume of the upper airway and decreased oxygen saturation levels. In regards to the control group, anteroposterior measurements positively correlated to all airway compartments and negatively correlated to Pediatric Sleep Questionnaire values. Vertically, longer faces exhibit larger airway compartments and decreased Polysomnography values