Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults

Enlarged tonsils, adenoids, and chronic respiratory problems have been associated with the compensatory adaptations of natural head posture (NHP) in children. Recently, it has been shown that adult patients with Obstructive Sleep Apnoea (OSA) also tend to exhibit a craniocervical extension (CCE) with a forward head posture (FHP). This study was designed to search for some characteristics of OSA patients that may be related to these adaptive changes in NHP. Overnight polysomnographic, demographic, and cephalometric records of 252 adult male subjects with various types of skeletal patterns and dental conditions were examined. Apnoea Index (AI) and Apnoea + Hypopnoea Index (AHI) variables were assessed to separate the non-apnoeic snorers (n = 35), and mild (n = 101), moderate (n = 63), and severe (n = 53) OSA groups. Results of the Tukey tests revealed that severe OSA patients had a greater tendency to exhibit a CCE with a FHP (P < or = 0.05 to P < or = 0.001). Differences in head extension (NSL.VER) between groups could not be identified. Pearson's 'r' correlation coefficients revealed that the CCE and FHP in OSA patients were associated with a higher disease severity, a longer and larger tongue, a lower hyoid bone position in relation to the mandibular plane, a smaller nasopharyngeal and a larger hypopharyngeal cross-sectional area, and a higher body mass index (P < or = 0.05 to P < or = 0.001). It is concluded that a CCE with a FHP is more likely to be seen in severe and obese OSA patients with certain morphological characteristics of the upper airway and related structures.