A comprehensive cephalometric analysis of cervico-craniofacial skeletal morphology in 100 male patients with obstructive sleep apnoea (OSA) and 36 male controls was performed. The significant aberrations in the OSA group feature: (1) shorter dimension of cranial base with slight counter-clockwise rotation and depression of clivus; (2) shorter maxillary length with normal height; (3) maxillo-mandibular retrognathia related to nasion perpendicular plane (N perpendicular FH) despite normal angles of prognathism; (4) 47 per cent of the OSA group had mandibular retrognathia; (5) increased anterior lower facial height and mandibular plane angle; (6) reduced size of bony pharynx; (7) inferiorly positioned hyoid bone at C4-C6 level; (8) deviated head posture with larger cranio-cervical angle. Cephalometric analysis is highly recommended in OSA patients as one of the most important tools in diagnosis and treatment planning.

A comprehensive cephalometric analysis of uvulo-glossopharyngeal morphology in 100 patients with obstructive sleep apnoea (OSA) and 36 controls was performed. The aberrations in OSA patients included: 1. Increased length, thickness, and sagittal area of soft palate (PM-U; SPT; SPA: P < 0.001) with a more upright position (NL/PM-U: P < 0.05) and 15 per cent more pharyngeal area occupation [SPA/(OPA-OA): P < 0.001]. 2. The contact length between the soft palate and the tongue was increased approximately two-fold (CL: P < 0.001). 3. The sagittal area of the tongue was 10 per cent larger (TA: P < 0.001) despite similar length and height and 3 per cent more oral area occupation (TA/OA: P < 0.05). 4. More upright tongue position (VT/FH: P < 0.05) and caudally extended tongue mass (V perpendicular FH: P < 0.05). 5. Decreased sagittal dimensions of nasopharynx (pm-UPW: P < 0.001), velopharynx (U-MPW: P < 0.001) and minimum distance between the base of the tongue and the posterior pharyngeal wall (PASmin: P < 0.001). 6. The residual oropharyngeal area (area not occupied by soft tissues) was 9 per cent less due to larger tongue and soft palate [(TA+SPA)/OPA: P < 0.001]. Cephalometric analysis is highly recommended in OSA patients as one of the most important tools in diagnosis and treatment planning.

PSG with simultaneous pharyngeal and esophageal pressure measurements of the upper airway may interfere with sleep architecture and cause a bias. The aim of this study was to evaluate the degree of disturbance to sleep caused by inclusion of pressure measurements of the airway, and whether this would reduce the validity of the PSG. Thirty-two consecutive patients referred for PSG for possible obstructive sleep apnea syndrome (OSAS) were included. For pressure recordings, a 6-F silicone tube, 1.9 mm in diameter, containing six pressure transducers, was introduced through one nostril into the pharynx and esophagus. Each patient had two nocturnal PSGs, one of which included airway pressure measurements. There were no statistically significant differences between PSGs performed with and without simultaneous pressure recordings for the following sleep quality parameters: total sleep time, number of sleep-stage shifts, sleep efficiency, arousal during sleep (= intrasleep wakefulness), percent REM sleep, and number of microarousals. We did not find any statistically significant differences for respiratory parameters such as type, duration, and index of different respiratory events and snoring. However, there was a slight tendency for reduced sleep quality and oxygen saturation when pressure measurements were included. The only significant change seen was in the duration of non-REM sleep with oxygen saturation below 90%. The multisensor airway pressure probe demonstrated that proximal obstructions were more common than distal obstructions, and obstruction in one or two segments was far more frequent than obstruction in more than two.

The site of obstruction in the upper aerodigestive tract in 20 snorers and/or patients with obstructive sleep apnea syndrome was determined by two methods: fiberoptic nasopharyngoscopy with the Müller manoeuvre and continuous, nocturnal pressure measurements in the upper aerodigestive tract supplemented with recording of O2 saturation and oro-nasal air-flow. Identical results were obtained by both methods in only 5 (25%) of the patients, whilst in 11 (55%) obstruction was recorded in the pharynx by the pressure method which could not be demonstrated by the Müller manoeuvre. The latter method is not sufficiently accurate and should no longer be used in the pre-treatment assessment of this group of patients. Measurement of pharyngeal pressure, O2 saturation and air-flow are recommended in the diagnostic work-up.

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