Role of Cone-Beam Computed Tomography (CBCT) in Obstructive Sleep Apnea (OSA): A Comprehensive Review

Obstructive sleep apnea (OSA) is characterized by recurrent partial or complete upper airway collapse during sleep. Accurate assessment of airway anatomy is crucial for risk stratification, diagnosis, and treatment planning. While polysomnography (PSG) is considered the gold standard for OSA diagnosis, it provides limited anatomical insights. Cone-beam computed tomography (CBCT) has emerged as a valuable tool with lower radiation dose for three-dimensional (3D) assessment of the upper airway space and craniofacial structures. CBCT enables precise measurement of critical airway parameters including total airway volume and length, minimum cross-sectional area, linear dimensions of anteroposterior and lateral diameters, as well as soft tissue structures such as tongue, tonsils, and adenoids. This review aims to explore and comprehensively review the role of CBCT, primarily in upper airway assessment for OSA, with an emphasis on airway measurement parameters, anatomical reference landmarks, and the variabilities, in addition to its clinical applications in treatment planning and simulation and post-treatment efficacy evaluation. This review also highlights the technical considerations such image acquisition protocols, machine specifications and software algorithm, and patient positioning, which may affect measurement reliability and diagnostic accuracy. CBCT serves as a powerful adjunct in OSA diagnosis and management, enabling comprehensive assessment of the airway space and hard and soft tissue structures. It complements PSG by guiding personalized interventions such as maxillomandibular advancement or CPAP optimization. Standardized imaging protocols and consideration of patient positioning can further improve its clinical utility.