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Cephalometric Measurement of Upper Airway Length Correlates With the Presence and Severity of Obstructive Sleep Apnea

  • Srinivas M. Susarla
    Correspondence
    Address correspondence and reprint requests to Dr Susarla: Massachusetts General Hospital and Harvard School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Boston, MA 02114
    Affiliations
    Resident and OMS Foundation Fellow in Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
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  • Zachary R. Abramson
    Affiliations
    Intern, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
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  • Thomas B. Dodson
    Affiliations
    Professor of Oral and Maxillofacial Surgery, Visiting Oral and Maxillofacial Surgeon and Director, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
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  • Leonard B. Kaban
    Affiliations
    Walter C. Guralnick Professor and Chair, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
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Published:September 24, 2010DOI:https://doi.org/10.1016/j.joms.2010.06.196

      Purpose

      The purpose of this study was to measure upper airway length (UAL) on lateral cephalograms and to assess its relationship with the presence and severity of obstructive sleep apnea (OSA).

      Materials and Methods

      Using a case-control study design, the investigators enrolled a sample of cases defined as adult subjects with OSA and controls who were adult patients with skeletal Class II malocclusions. The primary predictor variable was UAL. Other variables were demographic and cephalometric parameters. The respiratory disturbance index (RDI) was used to measure disease severity in cases. Bivariate analyses were computed to evaluate the associations between predictor and outcome variables. Multiple regression analyses were used to provide adjusted measures of association, controlling for the effects of confounders/effect modifiers. Diagnostic test characteristics were computed for threshold airway lengths. P ≤ .05 was considered statistically significant.

      Results

      The sample consisted of 96 cases with OSA (76 males) and 56 controls without OSA (36 males). OSA subjects were older, were predominately male, and had higher body mass indexes and longer and narrower airways (P < .05). After controlling for confounding variables, UALs ≥72 mm for males and ≥62 mm for females were significantly associated with the presence of OSA (P = .03). The sensitivity and specificity of UAL as a diagnostic test for OSA were ≥0.8. UAL was strongly correlated with RDI (disease severity) in males (r = 0.72, P < .01) and moderately correlated with RDI in females (r = 0.52, P < .01).

      Conclusion

      Increased upper airway length was correlated with the presence and severity of OSA in this sample of adult patients.
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      Linked Article

      • Class II Division II Malocclusion Does Not Influence Upper Airway Length
        Journal of Oral and Maxillofacial SurgeryVol. 69Issue 5
        • Preview
          We recently received an inquiry from a reader regarding our article entitled “Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea.”1 The reader made the astute observation that, if there were a greater number of subjects without sleep apnea who had Class II Division II or “deep bite” malocclusions, the measurement of upper airway length could be potentially confounded by this factor. The reader's hypothesis was that a deep bite would be associated with a lower gonial angle, a more horizontally positioned mandible, and given the method of measuring upper airway length, an effectively shortened upper airway.
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