Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2005 Jun;60(6):504–510. doi: 10.1136/thx.2004.031591

Craniofacial profile in Asian and white subjects with obstructive sleep apnoea

B Lam 1, M Ip 1, E Tench 1, C Ryan 1
PMCID: PMC1747424  PMID: 15923252

Abstract

Background: Clinical detection of structural narrowing of the upper airway may facilitate early recognition of obstructive sleep apnoea (OSA). To determine whether the craniofacial profile predicts the presence of OSA, the upper airway and craniofacial structure of 239 consecutive patients (164 Asian and 75 white subjects) referred to two sleep centres (Hong Kong and Vancouver) were prospectively examined for suspected sleep disordered breathing.

Methods: All subjects underwent a history and physical examination with measurements of anthropometric parameters and craniofacial structure including neck circumference, thyromental distance, thyromental angle, and Mallampati oropharyngeal score. OSA was defined as an apnoea-hypopnoea index (AHI) of ⩾5/hour on full overnight polysomnography.

Results: Discriminant function analysis indicated that the Mallampati score (F = 0.70), thyromental angle (F = 0.60), neck circumference (F = 0.54), body mass index (F = 0.53), and age (F = 0.53) were the best predictors of OSA. After controlling for ethnicity, body mass index and neck circumference, patients with OSA were older, had larger thyromental angles, and higher Mallampati scores than non-apnoeic subjects. These variables remained significantly different between OSA patients and controls across a range of cut-off values of AHI from 5 to 30/hour.

Conclusions: A crowded posterior oropharynx and a steep thyromental plane predict OSA across two different ethnic groups and varying degrees of obesity.

Full Text

The Full Text of this article is available as a PDF (168.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cooke M. S., Wei S. H. A comparative study of southern Chinese and British Caucasian cephalometric standards. Angle Orthod. 1989 Summer;59(2):131–138. doi: 10.1043/0003-3219(1989)059<0131:ACSOSC>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  2. Durán J., Esnaola S., Rubio R., Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):685–689. doi: 10.1164/ajrccm.163.3.2005065. [DOI] [PubMed] [Google Scholar]
  3. Ferguson K. A., Ono T., Lowe A. A., Ryan C. F., Fleetham J. A. The relationship between obesity and craniofacial structure in obstructive sleep apnea. Chest. 1995 Aug;108(2):375–381. doi: 10.1378/chest.108.2.375. [DOI] [PubMed] [Google Scholar]
  4. Flemons W. W., Whitelaw W. A., Brant R., Remmers J. E. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994 Nov;150(5 Pt 1):1279–1285. doi: 10.1164/ajrccm.150.5.7952553. [DOI] [PubMed] [Google Scholar]
  5. Friedman M., Tanyeri H., La Rosa M., Landsberg R., Vaidyanathan K., Pieri S., Caldarelli D. Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999 Dec;109(12):1901–1907. doi: 10.1097/00005537-199912000-00002. [DOI] [PubMed] [Google Scholar]
  6. Grunstein R., Wilcox I., Yang T. S., Gould Y., Hedner J. Snoring and sleep apnoea in men: association with central obesity and hypertension. Int J Obes Relat Metab Disord. 1993 Sep;17(9):533–540. [PubMed] [Google Scholar]
  7. Hiremath A. S., Hillman D. R., James A. L., Noffsinger W. J., Platt P. R., Singer S. L. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth. 1998 May;80(5):606–611. doi: 10.1093/bja/80.5.606. [DOI] [PubMed] [Google Scholar]
  8. Isono S., Remmers J. E., Tanaka A., Sho Y., Sato J., Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol (1985) 1997 Apr;82(4):1319–1326. doi: 10.1152/jappl.1997.82.4.1319. [DOI] [PubMed] [Google Scholar]
  9. Ito D., Akashiba T., Yamamoto H., Kosaka N., Horie T. Craniofacial abnormalities in Japanese patients with severe obstructive sleep apnoea syndrome. Respirology. 2001 Jun;6(2):157–161. doi: 10.1046/j.1440-1843.2001.00325.x. [DOI] [PubMed] [Google Scholar]
  10. Jamieson A., Guilleminault C., Partinen M., Quera-Salva M. A. Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep. 1986 Dec;9(4):469–477. doi: 10.1093/sleep/9.4.469. [DOI] [PubMed] [Google Scholar]
  11. Kapuniai L. E., Andrew D. J., Crowell D. H., Pearce J. W. Identifying sleep apnea from self-reports. Sleep. 1988 Oct;11(5):430–436. doi: 10.1093/sleep/11.5.430. [DOI] [PubMed] [Google Scholar]
  12. Kushida C. A., Efron B., Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med. 1997 Oct 15;127(8 Pt 1):581–587. doi: 10.7326/0003-4819-127-8_part_1-199710150-00001. [DOI] [PubMed] [Google Scholar]
  13. Li K. K., Kushida C., Powell N. B., Riley R. W., Guilleminault C. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope. 2000 Oct;110(10 Pt 1):1689–1693. doi: 10.1097/00005537-200010000-00022. [DOI] [PubMed] [Google Scholar]
  14. Lowe A. A., Fleetham J. A., Adachi S., Ryan C. F. Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop. 1995 Jun;107(6):589–595. doi: 10.1016/s0889-5406(95)70101-x. [DOI] [PubMed] [Google Scholar]
  15. Lowe A. A., Ono T., Ferguson K. A., Pae E. K., Ryan C. F., Fleetham J. A. Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 1996 Dec;110(6):653–664. doi: 10.1016/s0889-5406(96)80043-6. [DOI] [PubMed] [Google Scholar]
  16. Lowe A. A., Santamaria J. D., Fleetham J. A., Price C. Facial morphology and obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 1986 Dec;90(6):484–491. doi: 10.1016/0889-5406(86)90108-3. [DOI] [PubMed] [Google Scholar]
  17. Lundström F., Lundström A. Natural head position as a basis for cephalometric analysis. Am J Orthod Dentofacial Orthop. 1992 Mar;101(3):244–247. doi: 10.1016/0889-5406(92)70093-P. [DOI] [PubMed] [Google Scholar]
  18. Mallampati S. R., Gatt S. P., Gugino L. D., Desai S. P., Waraksa B., Freiberger D., Liu P. L. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985 Jul;32(4):429–434. doi: 10.1007/BF03011357. [DOI] [PubMed] [Google Scholar]
  19. Maltais F., Carrier G., Cormier Y., Sériès F. Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea. Thorax. 1991 Jun;46(6):419–423. doi: 10.1136/thx.46.6.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Miyajima K., McNamara J. A., Jr, Kimura T., Murata S., Iizuka T. Craniofacial structure of Japanese and European-American adults with normal occlusions and well-balanced faces. Am J Orthod Dentofacial Orthop. 1996 Oct;110(4):431–438. doi: 10.1016/s0889-5406(96)70047-1. [DOI] [PubMed] [Google Scholar]
  21. Peker Yüksel, Hedner Jan, Norum Jeanette, Kraiczi Holger, Carlson Jan. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med. 2002 Jul 15;166(2):159–165. doi: 10.1164/rccm.2105124. [DOI] [PubMed] [Google Scholar]
  22. Ross S. D., Sheinhait I. A., Harrison K. J., Kvasz M., Connelly J. E., Shea S. A., Allen I. E. Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea. Sleep. 2000 Jun 15;23(4):519–532. [PubMed] [Google Scholar]
  23. Rowley J. A., Aboussouan L. S., Badr M. S. The use of clinical prediction formulas in the evaluation of obstructive sleep apnea. Sleep. 2000 Nov 1;23(7):929–938. doi: 10.1093/sleep/23.7.929. [DOI] [PubMed] [Google Scholar]
  24. Schellenberg J. B., Maislin G., Schwab R. J. Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):740–748. doi: 10.1164/ajrccm.162.2.9908123. [DOI] [PubMed] [Google Scholar]
  25. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999 Aug 1;22(5):667–689. [PubMed] [Google Scholar]
  26. Stradling J. R., Crosby J. H. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991 Feb;46(2):85–90. doi: 10.1136/thx.46.2.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Tsai Willis H., Remmers John E., Brant Rollin, Flemons W. Ward, Davies Jan, Macarthur Colin. A decision rule for diagnostic testing in obstructive sleep apnea. Am J Respir Crit Care Med. 2003 Jan 24;167(10):1427–1432. doi: 10.1164/rccm.200112-110OC. [DOI] [PubMed] [Google Scholar]
  28. Zucconi M., Ferini-Strambi L., Palazzi S., Orena C., Zonta S., Smirne S. Habitual snoring with and without obstructive sleep apnoea: the importance of cephalometric variables. Thorax. 1992 Mar;47(3):157–161. doi: 10.1136/thx.47.3.157. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES