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Published on: December 6, 2016
Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis
Nathalia Carolina Fernandes Fagundes1, Silvia Gianoni-Capenakas1, Giseon Heo1
1School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Insights
This systematic review found limited evidence linking craniofacial features to pediatric obstructive sleep apnea (OSA). More research is needed to confirm any association between specific facial characteristics and OSA in children.
Area of Science:
- Pediatric Sleep Medicine
- Craniofacial Biology
- Otolaryngology
Background:
- Pediatric obstructive sleep apnea (OSA) is a common condition with potential long-term health consequences.
- Craniofacial morphology has been an area of interest in understanding OSA development.
- Previous studies have suggested potential links between facial structure and OSA in children.
Purpose of the Study:
- To systematically review and evaluate the association between craniofacial features and pediatric obstructive sleep apnea (OSA).
- To synthesize findings from existing clinical studies on craniofacial morphology in children with and without OSA.
Main Methods:
- A comprehensive search of seven databases was conducted.
- Included studies focused on participants under 18 with diagnosed OSA, evaluating skeletal, soft tissue, and dental arch features.
- Risk of bias, certainty of evidence, and meta-analysis were performed following PRISMA-2020 guidelines.
Main Results:
- Nine studies were identified; four reported differences in craniofacial features between children with and without OSA.
- Observed differences included mandibular retrognathia, reduced nasopharyngeal dimensions, longer facial profiles, and narrower intercanine width in children with OSA.
- Meta-analysis of cephalometric angles (SNA, SNB, ANB, NSBa, U1-L1, U1-SN) revealed no significant differences.
Conclusions:
- The current evidence, with very low to moderate certainty, does not support a definitive association between craniofacial morphology and pediatric OSA.
- Further high-quality research is required to establish a clear link or lack thereof.
- Limitations in the existing literature necessitate cautious interpretation of findings.
Study Objectives:
This review aimed to evaluate the association between craniofacial features in children and adolescents with pediatric obstructive sleep apnea (OSA).
Methods:
Seven databases were searched to fulfill our research objectives. Clinical studies that included participants younger than 18 years with fully diagnosed OSA or without OSA and that evaluated skeletal, soft craniofacial features, or dental arch morphology were considered for this review. The risk of bias and certainty of evidence were assessed. A meta-analysis was performed when low methodological and clinical heterogeneity were detected. This review followed the protocols recommended by the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA-2020) guidelines.
Results:
Nine studies were identified at the end of the selection process, from which 5 did not report differences. Four studies reported differences between craniofacial features when OSA was compared to an asymptomatic control group. Mandibular retrognathia, reduced anteroposterior linear dimensions of the bony nasopharynx (decreased pharyngeal diameters at the levels of the adenoids), longer facial profile, and a narrower intercanine width were described among children with OSA. A meta-analysis was performed considering the studies with a similar methodological approach, and no differences were observed in all the considered cephalometric angles (SNA, SNB, ANB, NSBa, U1-L1, U1-SN). All the included studies were considered at low risk of bias even though some limitations were noted.
Conclusions:
Due to the very low to moderate level of certainty, neither an association nor a lack thereof between craniofacial morphology and pediatric OSA can be supported by these data.
Citation:
Fagundes NCF, Gianoni-Capenakas S, Heo G, Flores-Mir C. Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2022;18(7):1865-1875.
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