Cone-beam computed tomography-based deep learning-augmented model for screening sleep-disordered breathing risk

Sleep-disordered breathing (SDB) is a common but underdiagnosed disorder due to complex diagnostic procedures, posing a substantial global health burden. Craniofacial anatomy, such as mandibular retrusion and upper airway narrowing, plays a prominent role in SDB among Asian populations, underscoring the potential role of orthodontists in SDB risk screening. This study aimed to develop a deep learning-augmented, cone-beam computed tomography-based model for SDB risk screening in adults.

A training cohort included 110 patients with SDB and 110 sex-matched nonsnoring controls, whereas an independent test cohort comprised 20 patients with SDB and 20 controls from another center. Pretrained convolutional neural networks were applied to lateral cephalograms, and multiple machine learning models were trained using cone-beam computed tomography-derived upper airway parameters. A late-fusion framework that integrated deep learning outputs with selected airway features was constructed using a random forest classifier. Explainability and visualization techniques were applied to improve interpretability.

Among the 6 pretrained convolutional neural network models evaluated using lateral cephalograms, ResNet-50 achieved the highest area under the curve (AUC) of 0.640. Second, when applied to upper airway volume parameters, the random forest classifier outperformed other machine learning algorithms, yielding an AUC of 0.908. The late-fusion model further improved screening performance, achieving an AUC of 0.925 and outperforming all single-modality models. Visualization analyses highlighted airway-related features that predispose to SDB, particularly within the palatopharyngeal region.

This deep feature-augmented fusion model demonstrates improved performance and interpretability for SDB risk screening. Routinely acquired orthodontic imaging may serve as a practical and orthodontist-friendly approach to support the early identification of patients at risk for SDB.