Cephalometric differences between patients with REM- and NREM-Predominant OSA: implications for selecting surgical candidates.

Abstract

Purpose: Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse, causing intermittent hypoxemia and sleep disruption. Various factors influence its occurrence and severity. This study aimed to examine the relationship between cephalometric anatomical features and polysomnographic data in patients with OSA.

Methods: This retrospective cohort study included 74 patients (61 male, 13 female) aged 18-78 years(mean ± SD: 52.9 ± 12.8 years), with BMI ranging 17.6-34 kg/m²(mean ± SD: 25.6 ± 3.1 kg/m²), diagnosed with OSA, who also underwent cephalometric, and panoramic radiographs. Patients were classified into positional OSA (n = 33, 28 males, 5 females), non-positional OSA (n = 41, 33 males, 8 females), REM-related OSA (n = 22, 14 males, 8 females) and NREM-related OSA (n = 52, 47 males, 5 females) based on polysomnographic data. The primary predictor variables were OSA subtype. The primary outcome variables included PSG data and lateral and posteroanterior cephalometric measurements. Group differences between OSA subtypes and correlation coefficient between PSG and cephalometric parameters were evaluated. Logistic regression analyses were performed to identify risk factor.

Results: No significant differences in cephalometric and panoramic parameters were found between patients with POSA and NPOSA. NREM OSA patients had a longer N-ANS length, greater anterior hyoid-to-mandibular plane, and longer tongue length than REM OSA patients (p < 0.05). Logistic regression revealed that narrower nasal and maxillary widths (relative to mandibular width) were significant risk factors for NPOSA (95% CI, p < 0.05). A posteriorly and inferiorly positioned hyoid bone and a longer tongue length were associated with NREM OSA.

Conclusion: Anatomical factors, including nasal and maxillary width, hyoid bone position, and tongue length, are linked to OSA type. These findings may suggest that targeted treatments strategies, including MAD, MMA, genioglossus advancement, or transverse maxillary expansion, may be effective based on individual anatomical characteristics.