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Three-dimensional orthodontic imaging in children across the age spectrum and correlations with obstructive sleep
Gemma Tyler1,2, Rita Machaalani2,3, Karen A Waters2,3
1Faculty of Science, University of Sydney, Camperdown, New South Wales 2006, Australia.
Insights
Facial convexity in children is linked to obstructive sleep apnea (OSA) severity. Three-dimensional imaging reveals that more obtuse facial angles correlate with severe OSA, offering a new diagnostic approach.
Area of Science:
- Craniofacial morphology
- Pediatric sleep medicine
- Medical imaging
Background:
- Obstructive sleep apnea (OSA) is a prevalent condition in children.
- Facial structure may influence OSA development and severity.
- Understanding craniofacial characteristics in relation to OSA is crucial for diagnosis and treatment.
Purpose of the Study:
- To establish baseline facial convexity measurements in children across different age groups.
- To investigate the correlation between facial convexity and the severity of obstructive sleep apnea (OSA) in pediatric patients.
- To explore the utility of stereophotogrammetry in assessing craniofacial structure in children with suspected OSA.
Main Methods:
- Collected polysomnogram, stereophotogrammetry, and biometric data from 91 children (aged 0.05-16.02 years) investigated for OSA.
- Analyzed facial convexity differences based on OSA severity, adjusting for age, sex, ethnicity, weight, and height.
- Utilized ordinal logistic regression and three-dimensional imaging techniques.
Main Results:
- Facial convexity was significantly influenced by age (P = 8.3·10⁻⁷) and sex (P = 1.3·10⁻²).
- A significant association was found between facial convexity and OSA severity (P = 2.2·10⁻³).
- Increasing obtuse facial convexity angles correlated with a higher likelihood of severe OSA classification.
Conclusions:
- Three-dimensional imaging demonstrated an impact of infancy on age-related changes in facial convexity.
- Distinct facial convexity patterns were observed across different OSA severity groups, even after adjusting for growth and demographic factors.
- Stereophotogrammetry offers a safe, cost-effective alternative for medical imaging in pediatric craniofacial studies.
Study Objectives:
To determine baseline facial convexity measurements in children with obstructive sleep apnea (OSA) across the age spectrum.
Methods:
Polysomnogram, stereophotogrammetry, and biometric data were collected from children aged 0-18 years who were being investigated for OSA. Analyses evaluated differences in facial convexity according to OSA severity and other sleep parameters, while adjusting for age, ethnicity, and sex.
Results:
Ninety-one children, aged 0.05-16.02 years, met the inclusion criteria for this study. Initial analysis showed that the logarithm of age had a significant effect on facial convexity (P = 8.3·10-7) with significant effects of sex (P = 1.3·10-2), while excluding OSA. Ordinal logistic regression taking into consideration age, sex, weight, height, and ethnicity with OSA severity categorized as obstructive apnea-hypopnea index negative, mild, moderate, or severe showed that facial convexity was associated with OSA severity (P = 2.2·10-3); an increasing obtuse angle of convexity increased the tendency to be classified as having severe OSA.
Conclusions:
Using three-dimensional imaging, we found an added impact of infancy on changes of facial convexity with age. While modeling could describe facial convexity without any OSA-associated sleep parameters, differences in facial convexity were present among groups with different levels of OSA severity adjusted for growth (age, weight, and height), sex, and ethnicity. The method provides a safer and cheaper alternative to other medical imaging techniques in children and holds potential for future use in studies of craniofacial structure.
Citation:
Tyler G, Machaalani R, Waters KA. Three-dimensional orthodontic imaging in children across the age spectrum and correlations with obstructive sleep apnea. J Clin Sleep Med. 2023;19(2):275-282.
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