Craniofacial phenotyping by photogrammetry in Chinese prepubertal children with obstructive sleep apnea

Abstract

Study Objectives This study aimed to examine the craniofacial phenotype of Chinese prepubertal children with and without OSA using a quantitative photographic analysis technique and to develop a prediction model for OSA diagnosis based on the photogrammetric data. Potential ethnic differences in the association between OSA and photogrammetric data between Chinese and Caucasian children were also examined. Methods This was a cross-sectional study. Chinese children aged 5-12 years old, suspected to have OSA were recruited from our sleep clinic. Frontal and side photos were taken for craniofacial phenotyping by photogrammetry. Polysomnography was performed and subjects were divided into three groups: non-OSA (obstructive apnea hypopnea index (OAHI) <1/h), mild OSA (OAHI between 1/h and 5/h), and moderate-to-severe (MS) OSA (OAHI ≥5/h). Prediction models were built from 70% of training data using logistic regression and evaluated on the remaining 30% of test data for ROC curve construction. Results This study included 90 subjects (mean age: 8.2 ± 1.6 years, 67 males). Non-OSA, mild OSA, and MS OSA groups included 32, 31, and 27 subjects, respectively. There were significant trends for an increasing maxillary-mandibular relationship angle (p=0.002) and a decreasing anterior mandibular height to whole face length ratio (p<0.001) with increasing OSA severity. A prediction model built with clinical measurements and the two photogrammetric features yielded an AUC of 0.81 (95% C.I.: 0.64-0.96). Conclusion Craniofacial features obtained by photogrammetry are significantly different between OSA groups in prepubertal children. Increased maxillary-mandibular relationship angle is an OSA feature found in both Asian and Caucasian children.

Development and Validation of a Nomogram for Predicting Obstructive Sleep Apnea Severity in Children

“… 59 Yuen found significant differences in the maxillary-mandibular relationship angle and the ratio of mandibular height to the entire length of the face in prepubertal children as the severity of OSA increased. 33 The model established by Masoud through three-dimensional airway analysis shows remarkable predictive value. 60 In summary, the use of craniofacial anthropometry and photogrammetry to assess facial features has been proposed as an alternative technique for OSA in both adults and children, and very low to moderate quality levels of data, have not been able to support the existence of an association, or lack thereof, between craniofacial morphology and pediatric OSA.…”

Craniofacial and upper airway morphological characteristics associated with the presence and severity of obstructive sleep apnea in Chinese children

“…The different cutoff values may influence the results. However, based on the recommendations of ICSD-3 and most researchers, we deemed it more appropriate to use the current cutoff value (51)(52)(53)(54)(55).…”

The Effects of Orofacial Myofunctional Therapy on Children with OSAHS’s Craniomaxillofacial Growth: A Systematic Review

“…In addition, prolonged mouth breathing gradually stretches the child’s head and neck forward, increasing the anterior craniocervical angle [ 15 , 16 ]. The angle between the mandible and maxilla rises sharply as OSAHS severity increases, and the proportion of anterior mandibular height to total face length considerably declines [ 17 ]. Motta et al reported craniocervical postural abnormalities in children with SB using digital photogrammetry [ 18 ].…”