Cephalometric differences in obstructive sleep apnea between obese and non-obese Korean male patients

Sang-Hee Hwang; In-Suk Park; Ki-Young Nam; Jong-Bae Kim; Yong-Won Cho; Young-Sung Suh; Byung-Hoon Ahn; Shin-Goo Park; Hyo-Sang Park

doi:10.4041/kjod.2008.38.3.202

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Hwang, Park, Nam, Kim, Cho, Suh, Ahn, Park, and Park: Cephalometric differences in obstructive sleep apnea between obese and non-obese Korean male patients

Original Article

Korean Journal of Orthodontics

Korean Journal of Orthodontics 2008; 38(3): 202-213.

Published online: 30 June 2008

DOI: https://doi.org/10.4041/kjod.2008.38.3.202

Cephalometric differences in obstructive sleep apnea between obese and non-obese Korean male patients

Sang-Hee Hwang, DDS, MSD, PhD^a, In-Suk Park, DDS, MSD^b, Ki-Young Nam, DDS, MSD, PhD^a, Jong-Bae Kim, DDS, MSD, PhD^c, Yong-Won Cho, MD, MSc, PhD^d, Young-Sung Suh, MD, MSc, PhD^e, Byung-Hoon Ahn, MD, MSc, PhD^f, Shin-Goo Park, MD, MSc, PhD^g, Hyo-Sang Park, DDS, MSD, PhD^h

^aAssistant Professor, Department of Dentistry, College of Medicine, Keimyung University, Korea.

^bClinical Full Time Lecturer, Department of Dentistry, College of Medicine, Keimyung University, Korea.

^cProfessor, Department of Dentistry, College of Medicine, Keimyung University, Korea.

^dAssociate Professor, Department of Neurology, College of Medicine, Keimyung University, Korea.

^eAssociate Professor, Department of Family Medicine, College of Medicine, Keimyung University, Korea.

^fAssociate Professor, Department of Otolaryngology, College of Medicine, Keimyung University, Korea.

^gAssistant Professor, Department of Occupational & Environmental Medicine, College of Medicine, Inha University, Korea.

^hAssociate Professor, Department of Orthodontics, College of Dentistry, Kyungpook National University, Korea.

Corresponding author: Sang-Hee Hwang. Department of Dentistry, Dong-San Medical Center, College of Medicine, Keimyung University, 194, Dongsan-dong, Jung-gu, Daegu 700-712, Korea. +82 53 250 7803; hsh99@dsmc.or.kr

Received 13 March 2007 Revised 20 June 2007 Accepted 22 June 2007

Abstract

Objective

The purpose of this study was to compare the cephalometric measurements of obese and non-obese Korean male patients with obstructive sleep apnea syndrome (OSA).

Methods

Eighty-seven adults who had visited the Sleep Disorder Clinic Center in Keimyung University, Daegu, Korea were examined and evaluated with polysomnography (PSG) and lateral cephalogram. They were divided into 4 groups (non-obese simple snorers, obese simple snorers, non-obese OSA patients, obese OSA patients) according to AHI (Apnea-Hypopnea Index) and BMI (Body Mass Index).

Results

The obese OSA group had the highest AHI among the 4 groups. The non-obese OSA group had a significantly steeper mandibular angle and shorter tongue length than the obese OSA group. The hyoid bone of the obese OSA group was positioned anterior and inferior as compared with the non-obese OSA group. Multiple regression analysis showed that tongue length in the obese OSA group and retroposition of hyoid bone in the non-obese OSA group were significant determinants for the severity of AHI.

Conclusions

From a cephalometric point of view, the obese and non-obese pateints with OSA may be characterized by different pathogeneses. Therefore, they have to be managed by individualized treatment. For the obese OSA patients, weight control must be advised as a first choice and for the non-obese OSA patients, oral appliance, nasal CPAP, UPPP and others could be chosen according to the obstructive sites.

Keywords: BMI, OSA, Lateral cephalogram, Individualized treatment

Figures and Tables

Fig. 1

Cephalometric landmarks. S (Sella), midpoint of the fossa hypophysealis; N (Nasion), anterior point at the frontonasal suture, Ba (Basion), most postero-inferior point on clivus; ANS (Anterior nasal spine), most anterior point of the nasal spine; PNS (Posterior nasal spine), most posterior point of the nasal spine; A, deepest anterior point in the concavity of the anterior maxilla; B, deepest anterior point in the concavity of the anterior mandible; Cd (Condylion), most postero-superior point of the condylar head; Gn (Gnathion), most antero-inferior point of the chin bone; Go (Gonion), a mid-point at the gonial angle located by bisecting the posterior and inferior borders of the mandible; Me (Menton), most inferior point of the chin bone; P, most inferior tip of soft palate; H, most antero-superior point of the hyoid bone; V, most antero-inferior point of the epiglottic fold; TT, most anterior point of the tip of the tongue; C3, most antero-inferior point of the third cervial vertebrae; MP (Mandibular plane), a tangent line constructed from Me to mandibular inferior border.

Table 1

Cephalometric measurements

Table 2

Characteristics of subjects

All data are presented as mean±SD; AHI, apnea-hypopnea index; ^a,b,cthe same letters indicate non-significant difference between groups based on Scheffe's multiple comparison test.

Table 3

Cephalometric measurements in simple snorers and OSA (obstructive sleep apnea syndrom) patients according to obesity

All data are presented as mean±SD; ^a,bthe same letters indicate non-significant difference between groups based on Scheffe's multiple comparison test.

Table 4

Correlations between cephalometric measurements and AHI (apnea-hypopnea index) in OSA patients

All data are correlation coefficient values; ^*p < 0.05; ^†p < 0.01.

Table 5

Stepwise multiple regression model for AHI (apnea-hypopnea index) in OSA patients according to obesity

1, Regression equation (Total), AHI = -5.562 + 1.283 (Tongue length) -2.047 (Nph1) -1.167 (Mn plane angle); 2, Regression equation (Obese), AHI = -111.336 + 1.656 (Tongue length); 3, Regression equation (Non-obese), AHI = 67.886 - 1.071 (C3-Hyoid).

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