Clustering-based characterization of clinical phenotypes in obstructive sleep apnoea using severity, obesity, and craniofacial pattern

An, Hyun-Joon; Baek, Seung‐Hak; Kim, Sung Wan; Park, Young-Guk

doi:10.1093/ejo/cjz041

Cited by 17 publications

(22 citation statements)

References 24 publications

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“…In order of frequency, the distribution of sagittal skeletal pattern was 57.2% of Class II, 32.3% of Class I, and 10.5% of Class III, while that of vertical skeletal pattern was 54.0% of hyperdivergent, 26.7% of normodivergent, and 19.3% of hypodivergent type ( Fig 3 ). As compared to the distribution of skeletal patterns in the healthy Korean population [ 29 ], Class II with retruded mandible and hyperdivergent vertical pattern were prevalent in OSA population, corresponding to the previous reports [ 26 – 28 ]. The prevalence of highly risky pattern of hyperdivergent Class II reached 39.1%, on the other hand, maxillary and mandibular protrusive patterns, which might be irrelevant to OSA pathogenesis, accounted for 25.1% and 20.1% of whole samples, respectively ( Table 2 ).…”

Section: Discussionsupporting

confidence: 81%

“…The phenotypic causative factors such as increased upper airway collapsibility, long duration of apnea and serious oxygen desaturation related to poor muscle responsiveness, high tendency of blood pressure increase or metabolic disturbance during REM sleep, and the degree of excessive daytime sleepiness and insomnia related to arousal threshold, turned out to have no statistical relations to the anatomical skeletal patterns in the present study. No predictive performance of craniofacial phenotyping for OSA risk or pathogenesis might be attributed to the speculations that (1) a multifactorial pathophysiologic mechanism is more frequently related to adult OSA than isolated simple causative factor [ 1 , 35 ], (2) not all states of anatomically collapsed upper airway by skeletal restriction result in functional disruption of respiration or sleep [ 28 , 36 ]. Based on this, this study highlights the importance of individualized craniofacial phenotyping in the process of OSA phenotyping, therapeutic target decision, and precision intervention or combination approach for each OSA patient.…”

Section: Discussionmentioning

confidence: 99%

“…Unadjusted odds ratio (OR) and 95% confidence interval (CI) were estimated by univariable logistic regression analysis for selected variables. The dependent variable was set as skeletal Class II with hyperdivergent pattern which is a known highly risky skeletal factor [ 26 – 28 ]. P -values of <0.05 were considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

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Respiratory and sleep characteristics based on frequency distribution of craniofacial skeletal patterns in Korean adult patients with obstructive sleep apnea

et al. 2020

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Objective To investigate the frequency distribution of various craniofacial skeletal patterns in a large Korean adult obstructive sleep apnea (OSA) population, and to find a relationship between craniofacial risks and respiratory and sleep characteristics. Methods A total of 1226 OSA patients (mean age of 44.9±13.3 years) were included in this retrospective cross-sectional study. All subjects were evaluated for gender and age using fourteen polysomnographic, five cephalometric, two comorbid variables, and three self-reported indexes. Frequency analysis was used to screen the distribution of main skeletal patterns and subtypes. Intergroup comparisons were performed using independent t-test, chi-square test or analysis of variance. Univariable regression analysis was done to find a relationship between skeletal risks and OSA characteristics. Results The frequency distribution of skeletal patterns was as follows: sagittally 57.2%, 32.3%, and 10.5% of Class II, Class I, and Cass III; vertically 54.0%, 26.7%, and 19.3% of hyperdivergent, normodivergent, and hypodivergent type, respectively. Polysomnographic, symptomatic, and comorbid variables showed no differences among patients with different skeletal patterns. Conversely, skeletal variables showed no differences according to OSA severity. The prevalence of highly risky skeletal pattern of hyperdivergent Class II was more likely to be females (OR 4.52, P < .01) and less obese (OR 3.21, P < .01), irrelevant to OSA and sleep characteristics.

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confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Respiratory and sleep characteristics based on frequency distribution of craniofacial skeletal patterns in Korean adult patients with obstructive sleep apnea

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“…Sleep monitoring through biometric shirts was found beneficial for screening purposes in adults but has not been evaluated in children yet 28 29. Identifying new validated screening methods will likely reduce healthcare costs, decrease diagnosis time and improve the follow-up of children with OSA 30…”

Section: Introductionmentioning

confidence: 99%

“… 28 29 Identifying new validated screening methods will likely reduce healthcare costs, decrease diagnosis time and improve the follow-up of children with OSA. 30 …”

Section: Introductionmentioning

confidence: 99%

Orthodontic interventions as a management option for children with residual obstructive sleep apnea: a cohort study protocol

et al. 2022

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Introduction Obstructive sleep apnoea (OSA) is a sleep-breathing disorder that seems likely to have long-term negative social and health consequences in children and adolescents. There are no established standard management approaches when the first line of therapy, the tonsillectomy and adenoidectomy (T&A), is not indicated or fails to address paediatric OSA (residual paediatric OSA). This protocol describes a prospective cohort study that aims to assess the effectiveness of orthodontic interventions for managing residual paediatric OSA in patients with concomitant craniofacial issues. Methods and analysis Children aged 6–16 years who with an OSA diagnosis and did not benefit from previous T&A or qualified for T&A will be recruited. Orthodontic intervention(s), when adequately indicated (maxillary expansion, mandibular advancement or maxillary complex advancement with skeletal anchored headgear), and a control (orthodontic intervention declined) cohorts will be involved. A sample size of 70 participants (n=35 per cohort) is planned. Effectiveness data will be assessed through nocturnal polysomnography, a craniofacial index, sleep questionnaires and medical records. Additionally, the association of residual OSA and two comorbidities, obesity and asthma, will be investigated through assessing blood, urine and saliva metabolites. The changes on body mass index will also be investigated as a secondary outcome. Other additional outcomes, including association between residual paediatric OSA and periodic limbs movement, restless leg syndrome, insomnia, and the use of abiometric shirt to sleep monitoring purposes will also be considered. All participants will be followed up for 12 months after treatment allocation. The effectiveness of the intervention will be analysed by the assessment of sleep parameters, medical history (from medical chart reviews), questionnaire responses, craniofacial characteristics and metabolomic markers using an algorithm to be developed. Ethics and dissemination This study was approved by the Health Research Ethics Board-Health Panel, University of Alberta, Edmonton, Canada (Pro00084763). The findings will be shared with scientific and patient content-specific social network communities to maximise their impact on clinical practice and future research in the study topic. Trial registration number NCT03821831; Pre-results.

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Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

et al. 2021

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Objectives This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes. Materials and methods Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4-6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson's correlation and t-tests were applied. Results Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly. Conclusions The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment. Clinical relevanceThe craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.

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Clustering-based characterization of clinical phenotypes in obstructive sleep apnoea using severity, obesity, and craniofacial pattern

Cited by 17 publications

References 24 publications

Respiratory and sleep characteristics based on frequency distribution of craniofacial skeletal patterns in Korean adult patients with obstructive sleep apnea

Respiratory and sleep characteristics based on frequency distribution of craniofacial skeletal patterns in Korean adult patients with obstructive sleep apnea

Orthodontic interventions as a management option for children with residual obstructive sleep apnea: a cohort study protocol

Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

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