J Rhinol.  2019 Nov;26(2):99-105. 10.18787/jr.2019.26.2.99.

Usefulness of Measuring Airway Length with Cephalometry in Pediatric Subjects with Obstructive Sleep Apnea

• Hwang JH
• Park DS
• Kim IH
• Lee H
• Park CS

• KMID: 2465541
• DOI: http://doi.org/10.18787/jr.2019.26.2.99

Abstract

BACKGROUND AND OBJECTIVES
This study was designed to analyze the relationship between measurement of airway length with cephalometry and AHI in children with OSA and to assess the correlations between cephalometric parameters and salivary cortisol level.
SUBJECTS AND METHOD
Three parameters of the upper airway were measured by cephalometry: distance from the posterior nasal spine to the hyoid bone (PHy), distance from the mandibular plane to the hyoid bone (MP-Hy), and distance from the posterior nasal spine to the mandibular plane (P-MP). Ratios for each segment were also determined.
RESULTS
Subjects with OSAS had longer P-Hy and MP-Hy than the control group. In particular, MP-Hy was significantly longer in the moderate-severe group than the other groups. In the OSAS group, there were significant correlations between MP-Hy, Ratio1, Ratio3 and m-Cor, s-Cor.
CONCLUSION
Length of upper airway and ratio parameters of cephalometry may be more useful indices in moderate-severe OSA than absolute distance parameters, and Ratio1 may be valuable for prediction of activating HPA axis.

Keyword

Sleep apnea, obstructive; Cephalometry; Child; Airway resistance

MeSH Terms

Airway Resistance
Cephalometry*
Child
Humans
Hydrocortisone
Hyoid Bone
Methods
Sleep Apnea, Obstructive*
Spine
Hydrocortisone

Figure

• 

  Fig. 1. Cephalometric landmarks and parameters. P: posterior nasal spine, MP: mandibular plane, Hy: the most anterior and su-perior point of hyoid bone.

Reference

References

1. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130:e714–55.

2. Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proceedings of the American Thoracic Society. 2008; 5:242–52.

3. Tan HL, Gozal D, Kheirandish-Gozal L. Obstructive sleep apnea in children: a critical update. Nature and science of sleep. 2013; 5:109–23.

4. De Luca Canto G, Singh V, Major MP, Witmans M, El-Hakim H, Major PW, et al. Diagnostic capability of questionnaires and clinical examinations to assess sleep-disordered breathing in children: a systematic review and metaanalysis. Journal of the American Dental Association (1939). 2014; 145:165–78.

6. Fujioka M, Young LW, Girdany BR. Radiographic evaluation of ad-enoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol. 1979; 133:401–4.

7. Jeong JH, Guilleminault C, Park CS, Son HL, Lee HK, Hwang SH, et al. Changes in salivary cortisol levels in pediatric patients with obstructive sleep apnea syndrome after adenotonsillectomy. Sleep Medicine. 2014; 15:672–6.

8. Park CS, Guilleminault C, Park HJ, Cho JH, Lee HK, Son HL, et al. Correlation of salivary alpha amylase level and adenotonsillar hypertrophy with sleep disordered breathing in pediatric subjects. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2014; 10:559–66.

9. Mitchell RB, Pereira KD, Friedman NR. Sleep-disordered breathing in children: survey of current practice. The Laryngoscope. 2006; 116:956–8.

10. Park JY, Choi SY, Lee JW, Ye MK, Shin SH. The Effect of Tonsil Size on the Obstructive Sleep Apnea in Adults. J Rhinol. 2011; 18(2):102–6.

11. Nolan J, Brietzke SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolar-yngology–head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2011; 144:844–50.

12. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Canadian journal of anaesthesia=Journal Canadien D'anesthesie. 2010; 57:423–38.

13. Susarla SM, Thomas RJ, Abramson ZR, Kaban LB. Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea. Int J Oral Maxillofac Surg. 2010; 39:1149–59.

14. Segal Y, Malhotra A, Pillar G. Upper airway length may be associated with the severity of obstructive sleep apnea syndrome. Sleep & breathing=Schlaf & Atmung. 2008; 12:311–6.

15. Susarla SM, Abramson ZR, Dodson TB, Kaban LB. Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons. 2010; 68:2846–55.

16. Arens R, McDonough JM, Corbin AM, Rubin NK, Carroll ME, Pack AI, et al. Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. American Journal of Respiratory and Critical Care Medicine. 2003; 167:65–70.

17. Vieira BB, Itikawa CE, de Almeida LA, Sander HH, Aragon DC, Anselmo-Lima WT, et al. Facial features and hyoid bone position in preschool children with obstructive sleep apnea syndrome. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology-Head and Neck Surgery. 2014; 271:1305–9.

18. Ping-Ying Chiang R, Lin CM, Powell N, Chiang YC, Tsai YJ. Sys-tematic analysis of cephalometry in obstructive sleep apnea in Asian children. Laryngoscope. 2012; 122:1867–72.

19. Lee KY, Lee CM, Choi YJ, Lee YJ, Jung SS, Kim JS. Comparison of Electron Beam Tomography and Multi Detector Computed To-mography for Dynamic Upper Airway Study in Snorers. J Rhinol. 2004; 11(1,2):57–61.