Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0036-1584295
Craniocervical Posture in Patients with Obstructive Sleep Apnea
Publication History
10 December 2015
18 April 2016
Publication Date:
01 July 2016 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025477/201603/lookinside/thumbnails/10-1055-s-0036-1584295_0410or-1.jpg)
Abstract
Introduction Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep.
Objective The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI).
Methods This case-control study evaluated 21 subjects with OSA, who comprised the OSA group (OSAG), and 21 healthy subjects, who constituted the control group (CG). Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry.
Results The groups were homogeneous regarding gender (12 men and 9 women in each group), age (OSAG = 41.86 ± 11.26 years; GC = 41.19 ± 11.20 years), and body mass index (OSAG = 25.65 ± 2.46 kg/m2; CG = 24.72 ± 3.01 kg/m2). We found significant differences between the groups, with lower average pharyngeal space and greater distance between the hyoid bone and the mandibular plane in OSAG, when compared with CG. A positive correlation was found between higher head hyperextension and head anteriorization, with greater severity of OSA as assessed by AHI.
Conclusion OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization.
-
References
- 1 Davatz AF, Andrade HLI, Melo IVP , et al. Síndromes da apneia e hipopnéia obstrutiva do sono: revisão da literatura. Rev Eletr Acerv Sau 2012; 1: 27-33
- 2 Arya D, Tripathi A, Singh SV, Tripathi S, Nagar A, Mishra A. A pilot study to evaluate posttreatment cephalometric changes in subjects with OSA. J Prosthet Dent 2010; 103 (3) 170-177
- 3 Thapa MA, Jayan BB, Nehra LCK, Agarwal MSS, Patrikar S, Brattacharya CD. Pharyngeal airway analysis in obese and non-obese patients with obstructive sleep apnea syndrome. Med J Armed Forces India 2014; 1-7
- 4 Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 2013; 188 (8) 996-1004
- 5 American Academy of Sleep Medicine (AASM). International classification of sleep disorders. 2nd ed. Diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine; 2005
- 6 Landmann N, Kuhn M, Piosczyk H , et al. The reorganisation of memory during sleep. Sleep Med Rev 2014; 18 (6) 531-541
- 7 Villanueva P, Valenzuela S, Santander H, Zúñiga C, Ravera MJ, Miralles R. Efecto de la postura de cabeza em mediciones de la vía aérea. Rev CEFAC 2004; 6: 44-48
- 8 Maschtakow PSL, Tanaka JLO, da Rocha JC , et al. Cephalometric analysis for the diagnosis of sleep apnea: a comparative study between reference values and measurements obtained for Brazilian subjects. Dental Press J Orthod 2013; 18 (3) 143-149
- 9 Salles C, Campos PSF, de Andrade NA, Daltro C. Obstructive sleep apnea and hypopnea syndrome: cephalometric analysis. Braz J Otorhinolaryngol 2005; 71 (3) 369-372
- 10 Ryu HH, Kim CH, Cheon SM , et al. The usefulness of cephalometric measurement as a diagnostic tool for obstructive sleep apnea syndrome: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119 (1) 20-31
- 11 Bharadwaj R, Ravikumar A, Krishnaswamy NR. Evaluation of craniofacial morphology in patients with obstructive sleep apnea using lateral cephalometry and dynamic MRI. Indian J Dent Res 2011; 22 (6) 739-748
- 12 Muto T, Takeda S, Kanazawa M, Yamazaki A, Fujiwara Y, Mizoguchi I. The effect of head posture on the pharyngeal airway space (PAS). Int J Oral Maxillofac Surg 2002; 31 (6) 579-583
- 13 Miyamoto K, Ozbek MM, Lowe AA, Fleetham JA. Effect of body position on tongue posture in awake patients with obstructive sleep apnoea. Thorax 1997; 52 (3) 255-259
- 14 Pracharktam N, Hans MG, Strohl KP, Redline S. Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects. Angle Orthod 1994; 64 (1) 63-73
- 15 Souza JA, Pasinato F, Basso D, Correa ECR, Silva AMT. Biophotogrammetry: reliability of measurements obtained with a posture assessment software (SAPO). Rev Bras Cineantropom Desempenho Hum. 2011; 13: 299-305
- 16 Lam B, Ooi CG, Peh WC , et al. Computed tomographic evaluation of the role of craniofacial and upper airway morphology in obstructive sleep apnea in Chinese. Respir Med 2004; 98 (4) 301-307
- 17 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (6) 540-545
- 18 Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131 (7) 485-491
- 19 Bertolazi AN, Fagondes SC, Hoff LS , et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med 2011; 12 (1) 70-75
- 20 Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013; 177 (9) 1006-1014
- 21 Visscher CM, De Boer W, Lobbezoo F, Habets LL, Naeije M. Is there a relationship between head posture and craniomandibular pain?. J Oral Rehabil 2002; 29 (11) 1030-1036
- 22 Weber P, Corrêa ECR, Milanesi JM, Soares JC, Trevisan ME. Craniocervical posture: cephalometric and biophotogrammetric analysis. Braz J Oral Sci 2012; 11: 416-421
- 23 Schulhof RJ. Consideration of airway in orthodontics. J Clin Orthod 1978; 12 (6) 440-444
- 24 Rocabado M. Biomechanical relationship of the cranial, cervical, and hyoid regions. J Craniomandibular Pract 1983; 1 (3) 61-66
- 25 Marques CG, Maniglia JV. Estudo cefalográfico de indivíduos com Síndrome da Apneia Obstrutiva do Sono: revisão de literatura. Arq Ciênc Saúde 2005; 12 (4) 206-212
- 26 Dancey C, Reidy J. Estatística Sem Matemática para Psicologia: Usando SPSS para Windows. Porto Alegre, Artmed. 2006
- 27 Muto T, Yamazaki A, Takeda S , et al. Relationship between the pharyngeal airway space and craniofacial morphology, taking into account head posture. Int J Oral Maxillofac Surg 2006; 35 (2) 132-136
- 28 Gungor AY, Turkkahraman H, Yilmaz HH, Yariktas M. Cephalometric comparison of obstructive sleep apnea patients and healthy controls. Eur J Dent 2013; 7 (1) 48-54
- 29 Sforza E, Bacon W, Weiss T, Thibault A, Petiau C, Krieger J. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2000; 161 (2 Pt 1): 347-352
- 30 Silva VG, Pinheiro LAM, Silveira PL , et al. Correlation between cephalometric data and severity of sleep apnea. Braz J Otorhinolaryngol 2014; 80 (3) 191-195
- 31 Yucel A, Unlu M, Haktanir A, Acar M, Fidan F. Evaluation of the upper airway cross-sectional area changes in different degrees of severity of obstructive sleep apnea syndrome: cephalometric and dynamic CT study. AJNR Am J Neuroradiol 2005; 26 (10) 2624-2629
- 32 Borges PdeT, Silva BB, Moita Neto JM, Borges NE, Li LM. Cephalometric and anthropometric data of obstructive apnea in different age groups. Braz J Otorhinolaryngol 2015; 81 (1) 79-84
- 33 Balasubramaniam R, Klasser GD, Cistulli PA, Lavigne GJ. The Link between Sleep Bruxism. Sleep Disordered Breathing and Temporomandibular Disorders: An Evidence-based Review JDSM 2014; 1: 27-37