Using craniofacial characteristics to predict optimum airway pressure in obstructive sleep apnea treatment

Manual titration is the gold standard to determinate optimal continuous positive airway pressure, and the prediction of the optimal pressure is important to avoid delays in prescribing a continuous positive airway pressure treatment.

To verify whether anthropometric, polysomnographic, cephalometric, and upper airway clinical assessments can predict the optimal continuous positive airway pressure setting for obstructive sleep apnea patients.

Fifty men between 25 and 65 years, with body mass indexes of less than or equal to 35kg/m² were selected. All patients had baseline polysomnography followed by cephalometric and otolaryngological clinical assessments. On a second night, titration polysomnography was carried out to establish the optimal pressure.

The average age of the patients was 43±12.3 years, with a mean body mass index of 27.1±3.4kg/m² and an apnea-hypopnea index of 17.8±10.5 events per hour. Smaller mandibular length (p=0.03), smaller atlas-jaw distance (p=0.03), and the presence of a Mallampati III and IV (p=0.02) were predictors for higher continuous positive airway pressure. The formula for the optimal continuous positive airway pressure was: 17.244-(0.133×jaw length)+(0.969×Mallampati III and IV classification)-(0.926×atlas-jaw distance).

In a sample of male patients with mild-to-moderate obstructive sleep apnea, the optimal continuous positive airway pressure was predicted using the mandibular length, atlas-jaw distance and Mallampati classification.