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

Petrykowski, Fabiana; Lam, Raymond; Lewis, Richard; Islam, Syed Mohammed Shamsul; Goonewardene, Mithran

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

Australasian Orthodontic Journal

Volume 38 (2022): Issue 2 (July 2022)

By:

Fabiana Petrykowski, Raymond Lam, Richard Lewis, Syed Mohammed Shamsul Islam and Mithran Goonewardene

Open Access

|Sep 2022

Figures & Tables

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.

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

DOI: https://doi.org/10.2478/aoj-2022-031 | Journal eISSN: 2207-7480 | Journal ISSN: 2207-7472

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Language: English

Page range: 307 - 318

Submitted on: May 1, 2022

Accepted on: Aug 1, 2022

Published on: Sep 29, 2022

Published by: Australian Society of Orthodontists Inc.

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2022 Fabiana Petrykowski, Raymond Lam, Richard Lewis, Syed Mohammed Shamsul Islam, Mithran Goonewardene, published by Australian Society of Orthodontists Inc.
This work is licensed under the Creative Commons Attribution 4.0 License.

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

Figures & Tables

Figure 1.

Figure 2.

Predicting key variables using multiple regression analysis_

Volumetric and morphologic variables and tongue channelling surgery_

Descriptive statistics_

Relationship between surgical procedure and other variables_

List of treatment for each patient_

Relationship between OSA, BMI and other variables_

Paradigm

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