Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome

Study objectives: The aims of this study were to comprehensively evaluate the cephalometric features of patients with. obstructive sleep apnea syndrome (OSAS), and to elucidate the relationship between cephalometric variables and severity of the apnea-hypopnea index (AHI). Patients: The study population consisted of 62 male patients with OSAS, classified into 33 obese patients (body mass index [BMI] greater than or equal to 27) and 29 nonobese patients (BMI < 27), and 13 male simple snorers (AHI < 5 events per hour). Method and measurements: Diagnostic polysomnography and measurements of 22 cephalometrie variables were carried out for all patients and simple snorers. Results: Patients with OSAS in both subgroups showed several significant cephalometric features compared with simple snorers: (1) inferiorly positioned hyoid bone, (2) enlarged soft palate, and (3) reduced upper airway width at soft palate. More extensive and severe soft-tissue enlargements including anteriorly positioned hyoid bone and a longer tongue were found in the obese patients. In the nonobese patients, the anteroposterior distances of the bony nasopharynx and oropharynx were significantly smaller than those of simple snorers and obese patients. Stepwise regression analysis showed that anterior displacement of the hyoid bone and retroposition of the mandible were the dominant overall determinants for AHI in patients with OSAS, and that narrowing of the bony oropharynx and inferior displacement of the hyoid bone were dominant determinants for AHI in nonobese patients. A significant regression model for AHI using cephalometric variables could not be obtained for the obese patients, but the BMI proved to be the most significant determinant. Conclusion: Characteristics of the craniofacial bony structure such as narrowing of the nasopharynx and oropharynx and enlargement of the soft tissue in the upper airway may be important risk factors for the development of OSAS in nonobese patients. In obese patients, the deposition of adipose tissue in the upper airway may aggravate the severity of OSAS.