Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: An inter-ethnic comparison

University of Groningen, Groningen, Groningen, Netherlands
The European Journal of Orthodontics (Impact Factor: 1.48). 02/2005; 27(1):91-7. DOI: 10.1093/ejo/cjh077
Source: PubMed


The aim of this study was to measure craniofacial morphology and nasal respiratory resistance (NRR) in Malay, Indian and Chinese subjects with obstructive sleep apnoea (OSA). The sample consisted of 34 male subjects, 27-52 years of age (Malay n = 11, which included five mild and six moderate-severe OSA; Indian n = 11, which included six mild and five moderate-severe OSA; and Chinese n = 12, which included six mild and six moderate-severe OSA) diagnosed using overnight polysomnography. After use of a decongestant, NRR was recorded using anterior and posterior rhinomanometry. Standardized lateral cephalometric radiographs were used to record linear and angular dimensions. Malay subjects with moderate-severe OSA had a shorter maxillary (sp-pm) and mandibular (gn-go) length when compared with a mild OSA reference sample (P < 0.05). The hyoid bone was located more caudally in the Chinese moderate-severe subjects (hy-NL, hy-ML)(P < 0.05), and may be a useful diagnostic indicator for severity in this racial group. No pattern of differences for NRR was seen between the moderate-severe and mild OSA subjects. The consistently lower values for nasopharyngeal resistance in all the moderate-severe subjects when compared with the mild group may indicate that some compensation at this level of the airway had taken place. Strong positive correlations between craniocervical angulation (NL/OPT) and total airway resistance and the turbulent component of flow (k(2)) suggest that head posture is sensitive to fluctuations in airway resistance (P < 0.01).

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Available from: Jan Huggare, Sep 22, 2015
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    • "Moreover, in patients with a unilateral malocclusion, asymmetric condylar position with an asymmetric condylar path was observed, [28,39] and this seems to reduce the mandibular condylar growth, [40] causing an asymmetric mandibular ramus length, that has been observed shorter in the crossbite side [41,42]. Based on the findings that asymmetric facial structures can be corrected only after early correction of a unilateral crossbite [28,41,43] it was suggested that a persisting asymmetric occlusion results in growth restriction that leads to mandibular and facial asymmetry [40,44-47] and later also to a vertebral column asymmetry. For this type of correlation, the role of the cervical column, as a link tract between the head and the vertebral column has been underlined. "
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    ABSTRACT: Idiopathic scoliosis is a deformity without clear etiology. It is unclear wether there is an association between malocclusion and scoliosis. Several types of occlusion were described in subjects with scoliosis, mostly case-reports. The aim of this review was to evaluate the type of occluslins more prevalent in subjects with scoliosis All randomised and controlled clinical trials identified from the Cochrane Oral Health Group Trials Register, a MEDLINE search using the Mesh term scoliosis, malocclusion, and relevant free text words, and the bibliographies of papers and review articles which reported the outcome of orthodontic treatment in subjects with scoliosis that were published as abstracts or papers between 1970 and 2010. All randomised and controlled clinical trials published as full papers or abstracts which reported quantitative data on the outcomes malocclusion in subjects with scoliosis. Data were extracted without blinding to the authors, age of patients or type of occlusion. Using the search strategy eleven observational longitudinal studies were identified. No randomized clinical trials were recorded. Twenty-three cross-sectional studies were recorderd, and the others studies were reviews, editorials, case-reports, or opinions. The clinical trials were often not controlled and were about the cephalometric evaluation after treatment with the modified Milwuakee brace, followed by the orthodontic treatment of the class II relationship with a functional appliance. Clinical trials also included the study of the associations between scoliosis and unilateral crossbite, in children with asymmetry of the upper cervical spine. This association was also investigated in rats, pigs and rabbits in clinical trials. The other associations between scoliosis and occlusion seems to be based only on cross-sectional studies, case-reports, opinions. Based on selected studies, this review concludes that there is plausible evidence for an increased prevalence of unilateral Angle Class II malocclusions associated with scoliosis, and an increased risk of lateral crossbite, midline deviation in children affected by scoliosis. Also, documentation of associations between reduced range of lateral movements and scoliosis seem convincing. Data are also mentioned about the association between plagiocephaly and scoliosis.
    Scoliosis 07/2011; 6(1):15. DOI:10.1186/1748-7161-6-15 · 1.31 Impact Factor
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    • "Li et al. (1999), in a comparative study of Asian and Caucasian male patients with OSA, demonstrated that Asians were less obese despite the presence of severe OSA. Craniofacial morphology differences were also noted among OSA subjects of three major ethnic populations in Asia (Wong et al., 2005). Malay subjects with moderate to severe OSA had a significantly shorter maxillary and mandibular length, whereas the hyoid bone was located more caudally in the moderate to severe Chinese subjects. "
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    ABSTRACT: The aim of this study was to compare the skeletal and soft tissue patterns between obstructive sleep apnoea (OSA) patients and control group of non-OSA patients. Fifty Malays (32 males and 18 females) aged 18-65 years divided into two equal groups 25 (17 males and 8 females) with OSA and a control group 25 subjects (15 males and 10 females). Both groups were diagnosed using polysomnography. Nineteen variables related to craniofacial skeletal and soft tissue morphology were measured on lateral cephalometric films. Analysis of covariance was used to compare the means between the two groups. The results showed that OSA subjects had a significant increase in body mass index (BMI) and neck circumference than the control group. The soft palate and tongue were longer and thicker in OSA patients. In addition, upper, middle, and lower posterior airway spaces were narrower, the hyoid bone was more inferior and posterior, and the cranial base flexure angle was significantly acute when compared with the control group. The findings indicate that craniofacial abnormalities play significant roles in the pathogenesis of OSA in Malay patients.
    The European Journal of Orthodontics 11/2010; 33(5):509-14. DOI:10.1093/ejo/cjq108 · 1.48 Impact Factor
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    • "Cephalometric studies of the cervical vertebral column area have also been performed on patients with obstructive sleep apnoea. Most of these studies agree that patients with obstructive sleep apnoea have an extended head posture [12, 24–31]. "
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    ABSTRACT: Aim. To summarize recent studies on morphological deviations of the cervical vertebral column and associations with craniofacial morphology and head posture in nonsyndromic patients and in patients with obstructive sleep apnoea (OSA). Design. In these recent studies, visual assessment of the cervical vertebral column and cephalometric analysis of the craniofacial skeleton were performed on profile radiographs of subjects with neutral occlusion, patients with severe skeletal malocclusions and patients with OSA. Material from human triploid foetuses and mouse embryos was analysed histologically. Results. Recent studies have documented associations between fusion of the cervical vertebral column and craniofacial morphology, including head posture in patients with severe skeletal malocclusions. Histological studies on prenatal material supported these findings. Conclusion. It is suggested that fusion of the cervical vertebral column is associated with development and function of the craniofacial morphology. This finding is expected to have importance for diagnostics and elucidation of aetiology and thereby for optimal treatment.
    International Journal of Dentistry 06/2010; 2010(1):295728. DOI:10.1155/2010/295728
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