Klazen Yoram P, Caron Cornelia J J M, Schaal Sontje C, Borghi Alessandro, Van der Schroeff Marc P, Dunaway David J, Padwa Bonnie L, Koudstaal Maarten J
Resident, Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Hospital, Sophia Children's Hospital Rotterdam, Rotterdam, the Netherlands.
Resident and PhD Student, Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Hospital, Sophia Children's Hospital Rotterdam, Rotterdam, the Netherlands.
J Oral Maxillofac Surg. 2019 Sep;77(9):1869-1881. doi: 10.1016/j.joms.2019.03.017. Epub 2019 Mar 26.
Obstructive sleep apnea (OSA) is a common problem in patients with craniofacial microsomia (CFM); however, the exact pathophysiology in patients with CFM remains unclear. The first aim of this study was to evaluate upper airway volume and morphology in patients with CFM. The second aim was to identify risk factors for the presence of OSA.
A cross-sectional study was set up and 3 study groups were identified: 1) CFM with OSA, 2) CFM without OSA, and 3) control. Computed tomographic (CT) scans of the head and neck were included and used to create 3-dimensional models. The age-matched control group consisted of patients evaluated for traumatic head injury or epilepsy. Volumetric and morphologic parameters were measured. The results of patients with CFM were compared among the 3 study groups. Descriptive statistics were computed using the Pearson χ test for categorical variables and nonparametric tests for continuous variables. A multiple variable regression model was used to identify risk factors for OSA.
In total, 79 patients with CFM were included, of which 25 patients were diagnosed with OSA. A total of 145 CT scans could be analyzed. In addition, a control population of 88 patients was identified. Oropharynx volume, mean cross-sectional area (CSA), minimal CSA, and minimal retropalatal area were found to be markedly smaller in patients with CFM compared with the control population. In contrast, in patients with CFM and OSA, minimal retroglossal area, sphericity, and uniformity markedly differed from those in patients without OSA. Sphericity was identified as the main predicting variable of OSA in patients with CFM.
The upper airway of patients with CFM is markedly smaller and puts them at risk for developing OSA. Patients with CFM diagnosed with OSA have a markedly smaller CSA behind the base of the tongue and a difference in sphericity.
阻塞性睡眠呼吸暂停（OSA）是颅面短小畸形（CFM）患者的常见问题；然而，CFM患者的确切病理生理学仍不清楚。本研究的首要目的是评估CFM患者的上气道容积和形态。第二个目的是确定OSA存在的危险因素。
开展一项横断面研究，确定了3个研究组：1）伴有OSA的CFM，2）不伴有OSA的CFM，3）对照组。纳入头部和颈部的计算机断层扫描（CT）并用于创建三维模型。年龄匹配的对照组由因创伤性脑损伤或癫痫接受评估的患者组成。测量容积和形态学参数。比较3个研究组中CFM患者的结果。使用Pearson χ检验对分类变量进行描述性统计，对连续变量进行非参数检验。采用多变量回归模型确定OSA的危险因素。
总共纳入了79例CFM患者，其中25例被诊断为OSA。总共可以分析145份CT扫描。此外，确定了88例患者的对照人群。发现CFM患者的口咽容积、平均横截面积（CSA）、最小CSA和最小腭后区明显小于对照人群。相比之下，伴有OSA的CFM患者的最小舌后区、球形度和均匀度与不伴有OSA的患者明显不同。球形度被确定为CFM患者OSA的主要预测变量。
CFM患者的上气道明显较小，使其有发生OSA的风险。被诊断为OSA的CFM患者在舌根后方有明显较小的CSA，并且在球形度上存在差异。
