Oral and maxillofacial radiology| Volume 123, ISSUE 1, P129-136.e3, January 2017

Correlation of upper airway radiographic measurements with risk status for obstructive sleep apnea syndrome in young dental patients

Published:October 17, 2016DOI:


      The aim of the present study is to compare radiographic measurements of the upper airway (UA) in young adult patients with different levels of risk status for obstructive sleep apnea syndrome.

      Study Design

      The study included 50 patients between 18 and 30 years of age who were referred for dental examination and evaluation of impacted third molars. Case record forms, including habit history, along with the Berlin Questionnaire and the Epworth Sleepiness Scale, were completed by the patients and their relatives. According to the answers, 25 low-risk patients and 25 high-risk patients were selected. Cephalometric radiographs and cone beam computed radiography images were obtained for radiographic analysis when the patients were admitted into the study.


      There were significant differences in body mass index, neck circumference measurements, Epworth score, and smoking status between risk groups. There were significant differences for UA measurements on radiographic evaluation. Body mass index (BMI) was found to be correlated positively with neck circumference and Epworth scores and negatively with UA measurements for all patients. Velopharyngeal measurements showed the highest correlation with Epworth scores, BMI, and neck circumference.


      The radiographic findings correlated with the survey results. Our data suggest that radiographic measurements of UA may be used as a predictor of risk for obstructive sleep apnea syndrome in a young population.
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        • Viswanath A.
        • Ramamurthy J.
        • Dinesh S.P.
        • Srinivas A.
        Obstructive sleep apnea: awakening the hidden truth.
        Niger J Clin Pract. 2015; 18: 1-7
        • Lam J.C.
        • Sharma S.K.
        • Lam B.
        Obstructive sleep apnoea: definitions, epidemiology & natural history.
        Indian J Med Res. 2010; 131: 165-170
        • Uyar M.
        • Elbek O.
        • Aydın N.
        • et al.
        Clinical profiles of obstructive sleep apnea syndrome.
        Turk Toraks Dergisi/Turkish Thorac J. 2008; 9: 113-116
        • Punjabi N.M.
        The epidemiology of adult obstructive sleep apnea.
        Proc Am Thorac Soc. 2008; 5: 136-143
        • Pamidi S.
        • Knutson K.L.
        • Ghods F.
        • Mokhlesi B.
        Depressive symptoms and obesity as predictors of sleepiness and quality of life in patients with REM-related obstructive sleep apnea: cross-sectional analysis of a large clinical population.
        Sleep Med. 2011; 12: 827-831
        • Vale J.
        • Manuel P.
        • Oliveira E.
        • et al.
        Obstructive sleep apnea and diabetes mellitus.
        Rev Port Pneumol. 2015; 21: 55-60
        • Davoudmanesh Z.
        • Bayat M.
        • Abbasi M.
        • Rakhshan V.
        • Shariati M.
        Cephalometric risk factors associated with myocardial infarction in patients suffering from obstructive sleep apnea: a pilot case-control study.
        Cranio. 2016; : 1-4
        • Navalkele D.D.
        • Barlinn K.
        • Minagar A.
        • Chernyshev O.Y.
        Exploration of screening practices for obstructive sleep apnea in stroke medical community: a pilot study.
        Pathophysiology. 2016; 23: 105-109
        • Demede M.
        • Pandey A.
        • Zizi F.
        • et al.
        Resistant hypertension and obstructive sleep apnea in the primary-care setting.
        Int J Hypertens. 2011; 2011: 340929
        • Gungor A.Y.
        • Turkkahraman H.
        • Yilmaz H.H.
        • Yariktas M.
        Cephalometric comparison of obstructive sleep apnea patients and healthy controls.
        Eur J Dent. 2013; 7: 48-54
        • Pereira E.J.
        • Driver H.S.
        • Stewart S.C.
        • Fitzpatrick M.F.
        Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea.
        J Clin Sleep Med. 2013; 9: 1259
        • Netzer N.C.
        • Stoohs R.A.
        • Netzer C.M.
        • Clark K.
        • Strohl K.P.
        Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.
        Ann Intern Med. 1999; 131: 485-491
        • Ahmadi N.
        • Chung S.A.
        • Gibbs A.
        • Shapiro C.M.
        The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance.
        Sleep Breath. 2008; 12: 39-45
        • Saleh A.B.M.
        • Ahmad M.A.
        • Awadalla N.
        Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients.
        Ann Thorac Med. 2011; 6: 212
        • Baumgartel K.L.
        • Terhorst L.
        • Conley Y.P.
        • Roberts J.M.
        Psychometric evaluation of the Epworth sleepiness scale in an obstetric population.
        Sleep Med. 2013; 14: 116-121
        • Walsh J.H.
        • Leigh M.S.
        • Paduch A.
        • et al.
        Evaluation of pharyngeal shape and size using anatomical optical coherence tomography in individuals with and without obstructive sleep apnoea.
        J Sleep Res. 2008; 17: 230-238
        • Rosenthal L.D.
        • Dolan D.C.
        The Epworth sleepiness scale in the identification of obstructive sleep apnea.
        J Nerv Ment Dis. 2008; 196: 429-431
        • Ulasli S.S.
        • Gunay E.
        • Koyuncu T.
        • et al.
        Predictive value of Berlin Questionnaire and Epworth Sleepiness Scale for obstructive sleep apnea in a sleep clinic population.
        Clin Respir J. 2014; 8: 292-296
        • Togeiro S.M.
        • Chaves Jr., C.M.
        • Palombini L.
        • Tufik S.
        • Hora F.
        • Nery L.E.
        Evaluation of the upper airway in obstructive sleep apnoea.
        Indian J Med Res. 2010; 131: 230-235
        • Sakamoto Y.
        • Yanamoto S.
        • Rokutanda S.
        • et al.
        Predictors of obstructive sleep apnoea-hypopnea severity and oral appliance therapy efficacy by using lateral cephalometric analysis.
        J Oral Rehabil. 2016; 43: 649-655
        • Almeida F.R.
        • Lowe A.A.
        • Sung J.O.
        • Tsuiki S.
        • Otsuka R.
        Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis.
        Am J Orthod Dentofacial Orthop. 2006; 129: 195-204
        • Abi-Ramia L.B.P.
        • Carvalho F.A.R.
        • Coscarelli C.T.
        Almeida MAdO. Increase in upper airway volume in patients with obstructive sleep apnea using a mandibular advancement device.
        Dental Press J Orthodont. 2010; 15: 166-171
        • Weissheimer A.
        • Menezes L.M.
        • Sameshima G.T.
        • Enciso R.
        • Pham J.
        • Grauer D.
        Imaging software accuracy for 3-dimensional analysis of the upper airway.
        Am J Orthod Dentofac Orthop. 2012; 142: 801-813
        • Fairburn S.C.
        • Waite P.D.
        • Vilos G.
        • et al.
        Three-dimensional changes in upper airways of patients with obstructive sleep apnea following maxillomandibular advancement.
        J Oral Maxillofac Surg. 2007; 65: 6-12
        • Park C.Y.
        • Hong J.H.
        • Lee J.H.
        • et al.
        Clinical effect of surgical correction for nasal pathology on the treatment of obstructive sleep apnea syndrome.
        PLoS One. 2014; 9: e98765
        • Poon K.H.
        • Chay S.H.
        • Chiong K.F.
        Airway and craniofacial changes with mandibular advancement device in Chinese with obstructive sleep apnoea.
        Ann Acad Med Singapore. 2008; 37: 637-644
        • Tangugsorn V.
        • Skatvedt O.
        • Krogstad O.
        • Lyberg T.
        Obstructive sleep apnoea: a cephalometric study. Part II. Uvulo-glossopharyngeal morphology.
        Eur J Orthod. 1995; 17: 57-67
        • Abrishami A.
        • Khajehdehi A.
        • Chung F.
        A systematic review of screening questionnaires for obstructive sleep apnea.
        Can J Anaesth. 2010; 57: 423-438
        • Sagaspe P.
        • Leger D.
        • Taillard J.
        • Bayon V.
        • Chaumet G.
        • Philip P.
        Might the Berlin Sleep Questionnaire applied to bed partners be used to screen sleep apneic patients?.
        Sleep Med. 2010; 11: 479-483
        • Gus M.
        • Gonçalves S.C.
        • Martinez D.
        • et al.
        Risk for obstructive sleep apnea by Berlin Questionnaire, but not daytime sleepiness, is associated with resistant hypertension: a case–control study.
        Am J Hypertens. 2008; 21: 832-835
        • Kang K.
        • Park K.-S.
        • Kim J.-E.
        • et al.
        Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study.
        Sleep Breath. 2013; 17: 803-810
        • Phillips B.
        • Kryger M.H.
        Management of obstructive sleep apnea-hypopnea syndrome: overview.
        in: Kryger M.H. Roth T. Dement W.C. Principles and Practice of Sleep Medicine. 4th ed. Elsevier, Philadelphia, PA2005: 1109-1121
        • Young T.
        • Shahar E.
        • Nieto F.J.
        • et al.
        Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study.
        Arch Intern Med. 2002; 162: 893-900
        • Bixler E.O.
        • Vgontzas A.N.
        • Ten Have T.
        • Tyson K.
        • Kales A.
        Effects of age on sleep apnea in men: I. Prevalence and severity.
        Am J Respir Crit Care Med. 1998; 157: 144-148
        • Bixler E.O.
        • Vgontzas A.N.
        • Lin H.M.
        • et al.
        Prevalence of sleep-disordered breathing in women: effects of gender.
        Am J Respir Crit Care Med. 2001; 163: 608-613
        • Yildirim Y.
        • Yilmaz S.
        • Guven M.
        • et al.
        Evaluation of anthropometric and metabolic parameters in obstructive sleep apnea.
        Pulm Med. 2015; 2015: 189761
      1. Schwab R, Goldberg A, Pack A. Sleep apnea syndromes. In: Fishman AP, Elias JA, eds. Fishman's Pulmonary Diseases and Disorders. New York: McGraw-Hill; 1998;1617:37.

        • Franklin K.A.
        • Gislason T.
        • Omenaas E.
        • et al.
        The influence of active and passive smoking on habitual snoring.
        Am J Respir Crit Care Med. 2004; 170: 799-803
        • Kushida C.A.
        • Morgenthaler T.I.
        • Littner M.R.
        • et al.
        Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005.
        Sleep. 2006; 29: 240-243
        • Abramson Z.R.
        • Susarla S.
        • Tagoni J.R.
        • Kaban L.
        Three-dimensional computed tomographic analysis of airway anatomy.
        J Oral Maxillofac Surg. 2010; 68: 363-371
        • Cossellu G.
        • Biagi R.
        • Sarcina M.
        • Mortellaro C.
        • Farronato G.
        Three-dimensional evaluation of upper airway in patients with obstructive sleep apnea syndrome during oral appliance therapy.
        J Craniofac Surg. 2015; 26: 745-748
        • Aboudara C.
        • Nielsen I.
        • Huang J.C.
        • Maki K.
        • Miller A.J.
        • Hatcher D.
        Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography.
        Am J Orthod Dentofacial Orthop. 2009; 135: 468-479