Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.
Dentomaxillofac Radiol. 2021 May 1;50(4):20200425. doi: 10.1259/dmfr.20200425. Epub 2020 Nov 5.
Both obesity and craniofacial deformity are important etiologies of obstructive sleep apnea (OSA). The present research aimed to explore their interaction and different impacts on OSA severity.
A total of 207 consecutive OSA patients (169 males, 38 females) were included in the research. Based on the body mass index (BMI) value, patients were divided into 77 normal-weight patients (BMI <24 kg m), 105 overweight patients (24 ≤ BMI<28 kg m) and 26 obese patients (BMI ≥28 kg m). All accepted overnight polysomnography and standard lateral cephalogram. Cephalometric measurements involved 25 cephalometric variables. The correlations between these cephalometric variables, BMI and the apnea-hypopnea index (AHI) were evaluated.
For the whole sample after controlling for gender and age, stepwise regression analysis showed that the factors affecting AHI were increased BMI, narrowing posterior airway space, inferior displacement of hyoid and elongation of the tongue. When grouped by BMI, normal-weight group exhibited with more reduced maxillary length and mandible length, and steeper mandible plane than overweight and obese patients ( < 0.0167). Obese group showed least skeletal restriction and most prominent soft tissues enlargement ( < 0.0167). However, these skeletal indexes were not statistically correlated with AHI.
Obesity and skeletal malformations were both etiological factors of OSA, but obesity seemed to have a greater influence on AHI severity in all kinds of obese and thin OSA patients. Only in normal-weight group, it was affected by both cephalometric variables and BMI.
肥胖和颅面畸形都是阻塞性睡眠呼吸暂停（OSA）的重要病因。本研究旨在探讨它们之间的相互作用以及对 OSA 严重程度的不同影响。
共纳入 207 例连续 OSA 患者（男 169 例，女 38 例）。根据体重指数（BMI）值，将患者分为 77 例正常体重患者（BMI<24kg/m）、105 例超重患者（24≤BMI<28kg/m）和 26 例肥胖患者（BMI≥28kg/m）。所有患者均接受过夜多导睡眠图和标准侧位头颅侧位片检查。头影测量包括 25 个头影测量变量。评估这些头影测量变量、BMI 与呼吸暂停低通气指数（AHI）之间的相关性。
对整个样本在控制性别和年龄后，逐步回归分析显示，影响 AHI 的因素是 BMI 增加、后气道空间变窄、舌骨向下移位和舌体延长。按 BMI 分组后，正常体重组的上颌长度和下颌长度减小，下颌平面较陡，与超重和肥胖患者相比差异有统计学意义（<0.0167）。肥胖组骨骼畸形限制最小，软组织增大最明显（<0.0167）。然而，这些骨骼指标与 AHI 无统计学相关性。
肥胖和骨骼畸形都是 OSA 的病因，但肥胖似乎对各种肥胖和消瘦的 OSA 患者的 AHI 严重程度影响更大。仅在正常体重组，它同时受到头影测量变量和 BMI 的影响。
