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Airway morphology and its influence on OSA severity and surgical intervention: a retrospective study

Fabiana Petrykowski
Fabiana Petrykowski
, 
Raymond Lam
Raymond Lam
, 
Richard Lewis
Richard Lewis
, 
Syed Mohammed Shamsul Islam
Syed Mohammed Shamsul Islam
 et 
Mithran Goonewardene
Mithran Goonewardene
   | 29 sept. 2022
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Publié en ligne: 29 sept. 2022
Pages: 307 - 318
Reçu: 01 mai 2022
Accepté: 01 août 2022
DOI: https://doi.org/10.2478/aoj-2022-031
© 2022 Fabiana Petrykowski et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

Quick Ceph Studio, San Diego, CA. Cephalometric landmarks and reference lines (mm). S (sella), centre of sella turcica; N (nasion), V notch of frontal and nasal bones; A point, deepest point between ANS and upper incisor alveolus; B point, deepest point between pogonion and lower incisor alveolus; Ba (basion), most inferior point of occipital bone; ANS, tip of anterior nasal spine; PNS, tip of posterior nasal spine; Pog (Pogonion), most anterior point of symphysis; Me (menton), most inferior point of symphyseal outline; Gn (gnathion), most anterior and inferior point on bony chin; Gt (genial), most posterior point of genial tubercle; Hy (hyoid body), most antero superior point of the hyoid bone; Uvt (Uvula tip), most posterior inferior point of the uvula; Uv (Uvula), most posterior point of uvula; PAS (pharyngeal airway space); NL (nasal line); PAS-UP, minimal PAS between uvula and posterior pharyngeal wall; PAS-UT, minimal PAS between uvula tip and posterior pharyngeal wall; PAS-TP, minimal pharyngeal airway space between back of tongue and posterior pharyngeal wall; ANS-PNS, distance from ANS to PNS; Length of BN, PNS to basion; Hyoid-C3, distance between C3 (anterior and inferiorly) and hyoid (antero-superiorly); GT-hyoid, genial tubercle to hyoid distance; Length SP, distance from PNS to tip of uvula (midline); SP thick, maximum thickness of soft palate measured perpendicular to PNS to uvula line.
Quick Ceph Studio, San Diego, CA. Cephalometric landmarks and reference lines (mm). S (sella), centre of sella turcica; N (nasion), V notch of frontal and nasal bones; A point, deepest point between ANS and upper incisor alveolus; B point, deepest point between pogonion and lower incisor alveolus; Ba (basion), most inferior point of occipital bone; ANS, tip of anterior nasal spine; PNS, tip of posterior nasal spine; Pog (Pogonion), most anterior point of symphysis; Me (menton), most inferior point of symphyseal outline; Gn (gnathion), most anterior and inferior point on bony chin; Gt (genial), most posterior point of genial tubercle; Hy (hyoid body), most antero superior point of the hyoid bone; Uvt (Uvula tip), most posterior inferior point of the uvula; Uv (Uvula), most posterior point of uvula; PAS (pharyngeal airway space); NL (nasal line); PAS-UP, minimal PAS between uvula and posterior pharyngeal wall; PAS-UT, minimal PAS between uvula tip and posterior pharyngeal wall; PAS-TP, minimal pharyngeal airway space between back of tongue and posterior pharyngeal wall; ANS-PNS, distance from ANS to PNS; Length of BN, PNS to basion; Hyoid-C3, distance between C3 (anterior and inferiorly) and hyoid (antero-superiorly); GT-hyoid, genial tubercle to hyoid distance; Length SP, distance from PNS to tip of uvula (midline); SP thick, maximum thickness of soft palate measured perpendicular to PNS to uvula line.

Figure 2.

3D Measurements (3dMDVultus software, 3dMD, Atlanta, GA).
3D Measurements (3dMDVultus software, 3dMD, Atlanta, GA).

Predicting key variables using multiple regression analysis.

Obstructive Sleep Apnoea (Moderate to Severe)
Coefficient Std. Error t value p-value
(Intercept) -159.404 90.859 -1.754 0.0933
AP Diameter 2.655 1.596 1.663 0.1104
SNA 2.99 1.114 2.685 0.0135
ANB -3.729 2.492 -1.496 0.1488
PAS-UP -4.916 2.526 -1.946 0.0645
Length of BN -1.778 1.012 -1.757 0.0928
SP thick 4.072 2.291 1.778 0.0893
R2=0.3182, p-value: 0.1655

Volumetric and morphologic variables and tongue channelling surgery.

Volumetric Measurements
Coefficient Std. Error t value p-value
(Intercept) -21.33241 8.85015 -2.41 0.0159
Cross-sectional Area -0.05826 0.02799 -2.081 0.0374
Length 0.28107 0.10884 2.582 0.0098

Descriptive statistics.

Total Male Female
N Mean SD N Mean SD N Mean SD
BMI (kg/m2) 22 30.4 3.8 16 30.7 3.4 6 29.7 5.2
Cross SA (mm2) 32 51.2 25 25 56 24.4 6 34.7 22.1
ML Diameter 32 14.2 8.97 25 13.25 4.96 6 19.31 18.3
AP Diameter 32 3.48 3.6 25 3.72 3.84 6 2.81 2.79
Volume (cm3) 32 12.8 7.3 25 13.6 7.6 6 9.9 6
Length (mm) 32 83.4 7.9 25 84.2 7.1 6 80.3 11.3
SNA (deg) 32 81.9 5.1 25 81.8 4.5 6 80.1 5.7
SNB (deg) 32 78.9 5.2 25 78.9 5.2 6 77.3 4.3
ANB (deg) 32 3.6 2 25 3.8 2.1 6 2.6 1.4
PAS-NL (mm) 32 23.8 3.8 25 24.2 3.9 6 21.8 3.8
PAS-UP (mm) 32 3.4 2.4 25 3.6 2.6 6 2.5 1.3
PAS-UT (mm) 32 7.6 3.7 25 7.9 4 6 5.8 2.1
PAS-TP (mm) 32 9.7 5.5 25 9.8 5 6 9.7 7.9
Length BN (mm) 32 42.5 4.9 25 42.9 5.1 6 41.3 4.6
ANS-PNS (mm) 32 51.6 6.5 25 53.2 6.1 6 45.4 4
HYOID C3 (mm) 32 37.2 6.6 25 38.5 6.7 6 32.8 3.9
GT HYOID (mm) 32 39.3 5.3 25 40 5.4 6 36.6 4.8
Length SP (mm) 32 39.7 8.3 25 40.5 8.2 6 36.6 9.6
SP thick (mm) 32 11.2 1.9 25 11.4 1.5 6 10.3 3

Relationship between surgical procedure and other variables.

Uvulopalatopharyngoplasty Tongue Channelling
Variable Category Odds Ratio p-value Odds Ratio p-value
Patient
Sex 2.111 0.4664 1 1
Age 0.91 0.1003 1.017 0.7039
BMI 1.049 0.7136 0.889 0.3506
AHI/RDI 0.97 0.137 0.987 0.4605
3D Morphology
Cross-sectional Area (mm2) 1.007 0.7036 0.964 0.1086
ML Diameter (mm) 1.03 0.7204 0.939 0.3984
AP Diameter (mm) 0.991 0.9342 0.758 0.1395
Volume (cm3) 1.206 0.1341 1.073 0.2565
Length (mm) 1.163 0.0515 1.219 0.0132 *
2D Angular
SNA 0.923 0.341 0.965 0.6372
SNB 0.97 0.6967 0.937 0.39
ANB 0.789 0.2732 0.922 0.6657
2D Linear
PAS-NL 0.862 0.2475 1.079 0.484
PAS-UP 1.097 0.6425 0.756 0.2213
PAS-UT 1.159 0.256 0.765 0.0485 *
PAS-TP 1.188 0.0994 0.956 0.5316
Length of BN 0.915 0.2936 1.047 0.5454
ANS-PNS 0.977 0.7112 0.96 0.4946
HY0ID-C3 0.967 0.595 0.896 0.1047
GT-HYOID 0.929 0.3763 0.899 0.1545
Length SP 1.025 0.6604 1.01 0.8414
SP thick 0.91 0.6893 0.776 0.2509

List of treatment for each patient.

Treatment done Patients (N)
CPAP only 3
CPAP + Septoplasty 3
Maxillo advancement surgery 1
Septoplasty 1
UPPP + Septoplasty 1
UPPP 3
UPPP + lingual tonsilectomy 1
UPPP + Transpalatal advancement 6
UPPP + tongue channelling + transpalatal advancement 10
UPPP + tongue channelling 3

Relationship between OSA, BMI and other variables.

Obstructive Sleep Apnoea Body Mass Index
Variable Category Coefficient p-value Coefficient p-value
Patient
Sex -0.607 0.9555 1.022 0.591
Age 1.183 0.0161 * -0.017 0.8637
BMI 0.954 0.5035 0.024 0.5035
3D Morphology
Cross-sectional Area (mm2) -0.113 0.5172 0.001 0.9802
ML Diameter (mm) 0.032 0.9476 -0.11 0.1924
AP Diameter (mm) -0.149 0.9001 0.339 0.153
Volume (cm3) -0.614 0.3156 -0.036 0.7335
Length (mm) -1.039 0.0751 -0.152 0.1603
2D Angular
SNA 0.957 0.3126 0.158 0.3699
SNB 0.983 0.2754 0.268 0.1006
ANB -0.6 0.8023 -0.332 0.4512
2D Linear
PAS-NL -0.738 0.5182 0.132 0.5572
PAS-UP -1.408 0.4375 0.63 0.0418*
PAS-UT 0.17 0.8852 0.35 0.1352
PAS-TP -0.037 0.9632 0.37 0.0068 *
Length of BN -0.941 0.3443 0.244 0.207
ANS-PNS -0.389 0.6317 0.082 0.5711
HY0ID-C3 0.023 0.9751 0.355 0.0034 *
GT-HYOID 0.623 0.4508 0.357 0.026 *
Length SP -0.435 0.4788 0.242 0.0268 *
SP thick 1.939 0.4016 1.939 0.4016
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