Agha Bahn, Johal Ama
Oral Growth and Development Department, Institute of Dentistry, Queen Mary University of London, London, UK.
J Sleep Res. 2017 Apr;26(2):122-131. doi: 10.1111/jsr.12485. Epub 2016 Dec 26.
This systematic review and meta-analysis explores the association between facial phenotype and obstructive sleep apnea-hypopnea syndrome in adults. A comprehensive electronic (Medline via Ovid, Scopus, and Embase) database and reference search were undertaken in relation to imaging modalities for surface craniofacial assessments in subjects with sleep apnea. The outcome measures were surface facial dimensions, morphology and profile. The quality of studies was assessed and a meta-analysis conducted. The studies were weighted using the inverse variance method, and the random effects model was used to analyse data. This systematic review identified eight case-control studies. In five studies (906 participants), adults with sleep apnea showed increased weighted mean differences in neck circumference by 1.26 mm (P = 0.0001) with extensive heterogeneity between studies (I² = 93%). Only two studies (467 participants) shared the following outcomes: mandible length, lower facial height, mandible width and anterior mandible height parameters. The pooled results demonstrated obstructive sleep apnea syndrome was associated with larger parameters than controls. In conclusion, the surface facial assessment was able to demonstrate some characteristic morphological features, facilitating a meta-analysis, in adults with obstructive sleep apnea-hypopnea syndrome. The strength of these findings, however, was limited by the heterogeneity of the studies precluding the identification of a clear phenotype.
本系统评价和荟萃分析探讨了成人间面部表型与阻塞性睡眠呼吸暂停低通气综合征之间的关联。针对睡眠呼吸暂停患者的面部颅面评估成像方式，进行了全面的电子数据库（通过Ovid、Scopus和Embase检索Medline）及参考文献检索。结局指标为面部表面尺寸、形态和轮廓。对研究质量进行了评估并开展了荟萃分析。采用逆方差法对研究进行加权，并使用随机效应模型分析数据。本系统评价纳入了8项病例对照研究。在5项研究（906名参与者）中，睡眠呼吸暂停成人患者的颈围加权平均差异增加了1.26毫米（P = 0.0001），研究间存在广泛异质性（I² = 93%）。仅有2项研究（467名参与者）共享了以下结果：下颌骨长度、面下高度、下颌骨宽度和下颌骨前部高度参数。汇总结果表明，阻塞性睡眠呼吸暂停综合征患者的参数大于对照组。总之，面部表面评估能够在阻塞性睡眠呼吸暂停低通气综合征成人患者中显示出一些特征性形态学特征，有助于进行荟萃分析。然而，这些研究结果的力度受到研究异质性的限制，妨碍了明确表型的识别。
