TABLE VI.E.

Evidence on imaging and OSA diagnosis

Study	Year	LOE	Study design	Study groups	Clinical endpoint	Conclusion
Riley et al.559	1983	2b	Retrospective study	15 adult OSA patients, 10 controls	Cephalogram	Length of the soft palate and the position of the hyoid bone serve as important cephalometric landmarks in OSA patients.
Neelapu et al.229	2017	2a	Systematic review, meta- analysis	25 Studies	Cephalogram	Significant variables in OSA patients include increase in total anterior facial height, inferior hyoid bone position, and reduced pharyngeal airway space.
Armalaite et al.560	2015	2a	Systematic review, meta- analysis	11 Studies	Cephalogram	The most reliable parameters in OSA subjects are MP-H and upper posterior pharyngeal space. However, the diagnosis of OSA cannot be made using cephalograms as the sole investigative modality.
Ramachandran et al.561	2009	2a	Systematic review, meta- analysis	26 Studies	Multiple screening questionnaires, multiple history and physical examination elements, oximetry, cephalometry, and morphometry	No ideal preoperative screening tool exists for OSA in the surgical population. Preoperative screening tools including cephalometry may not identify a significant proportion of patients with OSA.
Guijarro- Martinez and Swennen562	2011	2a	Systematic review	5 studies (relationship between upper airway and OSA)	CBCT	Statistically significant difference between OSA and non-OSA patients in the ratio of the airway cross-section area/square area.
Hsu and Wu563	2019	2b	Retrospective study	21 normal subjects (no OSA)	Cephalogram, CBCT	Cephalograms in the upright position had a significantly larger MP-H when compared to CBCT derived cephalometric images in the supine position.
Chen et al.564	2016	2a	Systematic review	8 studies	CBCT	The most significant anatomical characteristic related to the pathogenesis of OSA is the small cross-sectional area of the airway (CSAmin). It is unclear how soft tissue structures interact to control upper airway dimensions.
Liu et al.565	2015	2b	Case–control study	15 mild adult OSA patients, 15 adult severe OSA patients	Sleep MRI	Based on sleep MRI, lateral pharyngeal wall collapse and low hyoid position are significantly associated with severe OSA.
Singh et al.566	2019	2a	Systematic review, meta-analysis	21 Studies (3339 patients)	Ultrasound	Airway parameters correlated with OSA: neck circumference and retropalatal diameter shortening during MM, tongue base thickness during MM, resting tongue base thickness, tongue base width, and LPW thickening. Non-airway: carotid plaque presence and carotid intimal thickening.