Table 1.
Characteristics of the included studies.
| Author/Year/ Study Design | Source of Sample | n | Age | Control Group Features | OSA Index | Ethnicity | BMI | Assessment of Adeno-tonsillar Size | Craniofacial Evaluation | Statistical analysis | Main Results |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Deng 2012/CS 18 | Beijing Children’s Hospital (sleep center) and Department of Orthodontics, Peking University, China | Total: 30 OSA: 15 Control: 15 | 9.5 ± 1.0 | Nonsnoring, first visit patients in Department of Orthodontics | Control group: AHI < 1; OSA: AHI = 6.29 ± 6.48 | Asian | NI | NI | Cephalometric analysis (20 morphologic variables). | Paired t tests, ANOVA | SNB (78.71 ± 2.61 vs75.82 ± 4.30), PG-NB (0.62 ± 0.60 mm vs 1.32 ± 0.84), Na-Me (108.50 ± 6.93 mm vs 13.62 ± 10.0 mm), and ANS-Me (61.51 ± 3.22 mm vs 65.12 ± 5.91 mm) showed statistical difference between control and OSA groups. A more inferior and retrusive hyoid was described in OSA group. |
| Di Francesco 2012/CC 19 | Otolaryngology Department of the University of São Paulo Medical School, Brazil. | Total: 77 OSA: 36 Control: 41 | 3.0–12.0 | Children with OSA symptoms | NI | NI | BMI z-score Male: –0.5 (–1.38, 0); Females: 0 –1.5, 0) | Yes | Cephalometric analysis (6 skeletal craniofacial variables). | Spearman’s rank correlation test | Facial depth (r = –.336), vertical growth tendency (r = –.337) and mandibular plane (r = .486) correlated with AHI in boys, but no correlations were found in girls. |
| Markkanen 2019/P-CH 20 | Tampere University Hospital, Finland | Total: 27 OSA: 9 Control: 18 | 1.9–2.8 | Nonsnoring children | Control group: NI; OSA: OAHI= 1.2–6.3 (median= 1.5) | NI | BMI: OSA group: 15.5–17.0; control: 16.0–17.8 | Yes | Dental and face evaluated by wax bite and profile photograph | Mann-Whitney U test | Children with OSAS (median: 27.0 mm) had narrower intercanine width than nonsnoring children (median: 28.2 mm). |
| Caiza Rennella 2017/CC 23 | Pontificia Universidad Javeriana, Colombia | Total: 43 OSA: 19 Control: 24 | 6.0–13.0 | Children with an indication to nPSG | NI | NI | NI | NI | Cephalometric analysis (12 skeletal craniofacial variables). | Independent t test and Mann-Whitney U test | Children with OSAS had same features as controls. |
| Soares 2020/CC 24 | Centro do Respirador Bucal of the Clinics Hospital Ribeirão Preto Medical School, University de São Paulo, Brazil | Total: 76 OSA: 62 Control: 14 | 7.0–10.0 | Children with respiratory and OSA symptoms | Control group: OAHI = 0.5 ± 0.2; OSA: OAHI = 13.0 ± 8.4 | NI | BMI> 95th percentile patients were excluded. | NI | Cephalometric analysis (9 skeletal craniofacial variables). | Independent t test | There were no differences between the 2 groups for any craniofacial measure. Children with OSA showed a more inferior hyoid position in relation to the mandibular plane (HyMP: control group = 10.9 ± 0.9 and OSA group = 13.1 ± 0.5; 95% CI: 0.08; 4.32). |
| Sutherland 2019/CC 11 | Melbourne Children’s Sleep Centre for PSG, Australia. | Total: 59 OSA: 50 Control: 9 | 7.2 ± 3.4 | Nonsnoring children | Control group: OAHI = 0.2 ± 0.3 for the control group; mild OSA group: OAHI = 2.8 ± 1.3; moderate-severe OSA group: OAHI= 14.5 ± 11.1 | 73.1% were Caucasian | BMI z-score: 0.6 ± 1.3 (− 3.7–3.3) | NI | Craniofacial measurements from 2-dimensional photography. | MANOVA | No association was observed between OSA and facial features. A direct association was observed between OSA severity and the inferior and posterior position of the hyoid bone. |
| Pirilä-Parkkinen 2009/CS 12 | Children referred from primary health care units to the Department of Otorhinolaryngology of Oulu University Hospital, Finland | Total: 123 OSA: 41 Snoring: 41 | 3.8–11.4 | Snoring children | Control group: AHI = 0.1 ± 0.2; OSA: AHI = 3.5 ± 3.60. | NI | NI | Yes | Dimensions of dental arches measured in upper and lower dental casts | ANOVA | Children with OSAS had same features as snoring children. |
| Pirilä-Parkkinen 2010/CS 21 | Children referred from primary health care units to the Department of Otorhinolaryngology of Oulu University Hospital, Finland | Total: 140 OSA: 26 Snoring: 27 Upper airway resistance syndrome: 17 Control: 70 | 4.7 ± 2.1 | Snoring children | Control group: AHI = 0.2 ± 0.1; OSA group: AHI = 2.5 ± 1.2 | NI | Only nonobese children | Yes | Cephalometric analysis (11 morphologic, 10 airway, 3 hyoid bone position, and 5 postural variables). | Paired t tests, ANOVA | Children with OSAS had same features than snoring children. |
| Wang 2012/CS 22 | Qilu Hospital, Shandong University, Jinan, China | Total: 70 OSA: 24 Snoring:12 Control: 34 | 9.6 ± 1.9 | Snoring children | Control group: AHI = 1.7 ± 1.2; OSA group: AHI = 8.5 ± 3.6 | NI | OSA: 14.790 ± 1.125 control: 15.993 ± 1.303 | NI | Cephalometric analysis (16 craniofacial skeletal variables, 7 craniofacial soft tissue variables). | ANOVA | Children with OSAS had same features as snoring children. A reduced anteroposterior linear dimensions of the bony nasopharynx (decreased pharyngeal diameters at the levels of the adenoids) was observed when children with OSA were compared to a non-nPSG group. |
AHI = apnea-hypopnea index, ANOVA = analysis of variance, ANS-Me = anterior nasal spine to menton point, BMI = body mass index, CC = case-control study design, CH = prospective cohort, CS = cross-sectional, HyMP = hyoid position in relation to the mandibular plane, MANOVA = Multivariate Analysis of Variance, Na-Me = nasion-A point to menton line, NI = Not indicated, OAHI = obstructive apnea-hypopnea index, OSA = obstructive sleep apnea, OSAS = OSA syndrome, PG-NB = pogonion to nasion-B point, PSG = polysomnography, SNB = sella-nasion to B point angle.