Characteristics of Skeletal Archial Analysis Facial Patterns in Adult Obstructive Sleep Apnea

Abstract

IntroductionSkeletal archial analysis in adult OSA has not been characterized. The specific aim of this study was to characterize archial analyses of adult subjects with known OSA. The primary research question of this study was: “What is the frequency of skeletal patterns from archial analysis in adult OSA subjects?” The authors hypothesized that adult subjects with OSA will follow a retrusive pattern skeletal archial analysis with high correlation with OSA severity. Materials and methodsA retrospective cohort study of adult polysomnogram (PSG)-confirmed OSA subjects’ charts was designed from subjects who presented to Allegheny General Hospital Division of Oral and Maxillofacial Surgery between January 1, 1992, and December 31, 2017. Inclusion criteria included PSG-confirmed OSA (AHI > 5), diagnostic lateral cephalometric radiographs, and demographic and diagnostic data. Exclusion criteria included subjects with a history of maxillofacial trauma or tumor surgery, craniofacial syndromes, and inadequate chart records. Independent predictor variables were age, sex, body-mass index (BMI), anterior arc independent (continuous data), and combined horizontal and vertical analyses (categorical data). Lateral cephalometric radiographs were analyzed with Dolphin software (v. 11.8) for Sassouni Plus archial analysis. Anterior arc analysis was recorded for maxillary incisor position to ANS (U1 - ANS arc), Point B to Point A arc (B - A arc), and pogonion to ANS arc (Pg - ANS arc). Skeletal facial types were categorized into 27 distinct facial types. Statistical analysisStandard descriptive and Spearman correlation (□) analysis was used with Excel. Results were reported as mean, standard deviation, and percentages. Standard error of measurement (SEM) and post-hoc power analysis were completed. Statistical significance was set at the P < .05 level. ResultsA total of 171 subject charts that met the inclusion criteria were included in this study. The cohort consisted of 124 females (73%). The cohort mean for age was 47 years (Standard deviation [SD] 11), for BMI 31 (6.5), for AHI 42 (30.5), for ESS 13 (4.9), and for nO2 81% (11). All ICC were greater than or equal to 0.90. Skeletal archial analyses revealed that the most frequent skeletal patterns were Class III at 44.7% (77/171), bimaxillary retrusion at 27% (46/171), Class II at 21.1% (36/171), Class I at 6.6% (11/152), and bimaxillary prognathism at 0.6% (1/171). Relative to the anterior arc, maxillary position was retrusive in 82.2% (141/171), ideal in 11.2% (19/171), and protrusive in 6.6% (11/171) of subjects. Also, relative the anterior arc, the mandible was in an ideal position in 45.3% (78/171), retrognathic in 33.6% (57/171), and prognathic in 21.1% (36/171) of subjects. Long vertical skeletal pattern was most frequent at 81.6% (140/171), normal at 14.5% (25/171), and short at 3.9% (7/171) of subjects. The most frequent skeletal patterns were Maxilla Retro, Mand Ideal AP; Long Vertical (49/171, 28.9%), Bi-Skeletal Retro AP; Short Vertical (41/171, 23.7%), and Maxilla Retro, Mand Prog AP; Long Vertical (26/171, 15.1%). There were only weak correlations between all independent and dependent variables (range P = .05 to .19). ConclusionWithin the limitations of this study, maxillary and bimaxillary retrusion patterns were frequent horizontal archial analysis skeletal positions as was long lower facial height. Most skeletal patterns involved maxillary retrusion, generally with long vertical lower face. All of the horizontal archial skeletal positions had weak correlations with severity of adult OSA. Additional research may be required to fully analyze the full diagnostic potential of skeletal archial analysis in diagnosis and treatment planning of subjects with OSAS.