Fifteen patients with obstructive sleep apnea syndrome (OSAS) and 10 controls were studied. Polygraphic monitoring during sleep confirmed the presence or absence of OSAS. Ten OSAS patients and five controls had cephalometric analysis and 12 OSAS patients and five controls had a flow-volume loop study during wakefulness. Seven OSAS patients were submitted to both analyses. Flow-volume loops were unable to detect extrathoracic airway obstruction in six out of 12 OSAS patients. One control was found with positive results. Six out of seven subjects with positive flow-volume loops were overweight (greater than or equal to 30% ideal weight). Cephalograms were very useful in demonstrating mandibular deficiencies in OSAS patients. The length of the soft palate and the position of the hyoid bone, together with the measurement of the posterior airway space, are criteria of great interest in OSAS patients. Cephalometric analysis is recommended in all OSAS patients scheduled for surgical procedure. None of these tests, however, whether alone or in combination, is capable of identifying all cases of OSAS.
"; the most relevant findings were the severe reduction of the posterior airway space (PAS ¼ 1 mm) and the elongation of soft palate (PNS-P ¼ 31 mm). The PAS is defined as the linear measurement between the base of the tongue and the posterior pharyngeal wall [Riley et al., 1983] "
"The linear craniofacial measurements selected were S-N, N-ANS, ANS-Me, Ar-Go, Go-Gn and AFAi, and the angular measurements taken were SN.SBa, SN.PP, SN.PO, SN.GoGn, SNA, SNB, ANB, and ArGo.GoGn [12e15] (Fig. 1 and Table 2). The pharyngeal widths measured were PPW1 , t-PPW , Ba-PNS , PAS , Ad1-Ba , and Ad2-So  (Fig. 2 and Table 3). The cephalogram was carried out twice by the same researcher within an interval of 30 days, and the error of the method was calculated using Dahlberg's formula, which established significant errors when the angular measurements were <1.5 and linear ones <1.0 mm  . "
[Show abstract][Hide abstract] ABSTRACT: Purpose
Evaluation of the correlation between adenoid hypertrophy, airway space, craniofacial morphology, and apnea–hypopnea index (AHI).
For the study, 21 children with obstructive sleep apnea (OSA) between 6 and 10 years of age (48% female) and 22 nasal breathing (control group, CG) children between 6 and 9 years of age (45% female) were included. Using the cephalometric analyses, 14 craniofacial measurements, four pharyngeal widths, and two adenoidal measurements were assessed. The t-test was used to detect significant differences in the craniofacial and airway space measurements between the groups. Pearson's correlation was used to correlate the cephalometric data and AHI.
The two craniofacial measurements were different between the groups. AFAi (p = 0.0407) increased in the OSA group and the ramus length was shorter in the CG (p = 0.030). The adenoid increased in OSA (Ad2-So p = 0.0028; Ad1-Ba p = 0.0021), while the airway space decreased (PPW1 p = 0.0084; t-ppw p = 0.0056; PSA, p = 0.001). A correlation was observed in both Ad2-So-AHI (R2 = 0.21; p = 0.037) and PPW1-AHI (R2 = 0.21; p = 0.035).
Few alterations in the craniofacial measurements were found; however, hypertrophy of the lymphoid tissues and airway space obstruction were observed. There was a correlation among the enlargement of lymphoid tissue, the airway space, and the AHI values. This study indicated that the narrowing of the airway space was more influenced by changes in soft tissue.
"The first, and more common, form is due to obstruction of the respiratory lumen, for example at the level of the retropalatal and retroglossal spaces, involving the soft palate and the base of the tongue . This obstruction, which can be partial or total, is linked to tissue factors such as tonsillar hypertrophy, but also to obesity, which can determine fatty infiltration of the pharyngeal wall [4,5]. The second, less frequent form is central OSAS, which is due to dysfunction of the cerebral mechanisms that control the pharyngeal muscles that keep the airways open during sleep. "
[Show abstract][Hide abstract] ABSTRACT: The present retrospective study analyzes sagittal cephalometric changes in patients affected by obstructive sleep apnea syndrome submitted to maxillomandubular advancement.
15 adult sleep apnea syndrome (OSAS) patients diagnosed by polysomnography (PSG) and treated with maxillomandubular advancement (MMA) were included in this study. Pre- (T1) and postsurgical (T2) PSG studies assessing the apnea/hypopnea index (AHI) and the lowest oxygen saturation (LSAT) level were compared. Lateral cephalometric radiographs at T1 and T2 measuring sagittal cephalometric variables (SNA, SNB, and ANB) were analyzed, as were the amount of maxillary and mandibular advancement (Co-A and Co-Pog), the distance from the mandibular plane to the most anterior point of the hyoid bone (Mp-H), and the posterior airway space (PAS).
Postoperatively, the overall mean AHI dropped from 58.7 ± 16 to 8.1 ± 7.8 events per hour (P < 0.001). The mean preoperative LSAT increased from 71% preoperatively to 90% after surgery (P < 0.001). All the patients in our study were successfully treated (AHI < 20 or reduced by 50%). Cephalometric analysis performed after surgery showed a statistically significant correlation between the mean SNA variation and the decrease in the AHI (P = 0.01). The overall mean SNA increase was 6°.
Our findings suggest that the improvement observed in the respiratory symptoms, namely the apnea/hypopnea episodes, is correlated with the SNA increase after surgery. This finding may help maxillofacial surgeons to establish selective criteria for the surgical approach to sleep apnea syndrome patients.
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