Miles P G, Vig P S, Weyant R J, Forrest T D, Rockette H E
University of Pittsburgh, Pa., USA.
Am J Orthod Dentofacial Orthop. 1996 Feb;109(2):163-72. doi: 10.1016/s0889-5406(96)70177-4.
The etiologic relevance of craniofacial structure to obstructive sleep apnea syndrome (OSAS) is controversial yet the premise of a causal association serves to justify many treatments. A qualitative and quantitative analysis of the literature was performed to examine the foundation for any relationship between craniofacial structure and OSAS. A MEDLINE search and investigation of the published and unpublished literature on diagnostic imaging and OSAS was toxonomically arranged. Each sample study was evaluated by using the following criteria: (a) appropriate control group, (b) "blinding" of evaluators, (c) reliability measured, (d) random assignment of treatment, and (e) "success" was defined adequately in efficacy studies. Morphologic variables were combined among studies and compared with controls drawn from either the same patient pool as the OSAS group, or matched for gender, age, and body mass index. Analysis revealed 32 review articles, 16 case reports, and 95 sample studies. Only seven sample studies drew a control group from the same patient pool, whereas five used matched controls. Only one of these studies satisfied all the qualitative criteria. Of the treatment efficacy studies, 10 defined outcome adequately. However, none of these met all the qualitative criteria. The most consistent, strong effect sizes with the highest potential diagnostic accuracies were for mandibular plane to hyoid, mandibular plane angle, and mandibular body length. Only mandibular body length demonstrated a clinically significant association with and diagnostic accuracy for OSAS. However, since this variable's controls were selected from the literature, possible explanations for a positive association include methodologic differences between studies, varying magnification factors, and morphologic differences.
颅面结构与阻塞性睡眠呼吸暂停综合征（OSAS）之间的病因学关联存在争议，但因果关系的前提为许多治疗方法提供了依据。我们对文献进行了定性和定量分析，以检验颅面结构与OSAS之间任何关系的基础。对MEDLINE进行了检索，并对已发表和未发表的有关诊断成像和OSAS的文献进行了分类整理。每个样本研究都根据以下标准进行评估：（a）适当的对照组；（b）评估者“盲法”；（c）测量可靠性；（d）治疗随机分配；（e）在疗效研究中对“成功”进行了充分定义。将各研究中的形态学变量进行合并，并与从与OSAS组相同的患者群体中抽取的对照组或按性别、年龄和体重指数匹配的对照组进行比较。分析发现了32篇综述文章、16篇病例报告和95项样本研究。只有7项样本研究从相同的患者群体中抽取对照组，而5项使用了匹配对照组。这些研究中只有1项满足所有定性标准。在治疗疗效研究中，10项对结局进行了充分定义。然而，这些研究均未满足所有定性标准。下颌平面至舌骨、下颌平面角和下颌体长的效应量最为一致、显著，且具有最高的潜在诊断准确性。只有下颌体长显示出与OSAS有临床显著关联并具有诊断准确性。然而，由于该变量的对照组是从文献中选取的，阳性关联的可能解释包括研究之间的方法学差异、不同的放大倍数以及形态学差异。
