The dentofacial and upper airway morphology of adults with obstructive sleep apnea: A systematic review and meta-analysis

The purpose of this systematic review is to summarize evidence regarding the dentofacial and upper airway features of obstructive sleep apnea (OSA) with adults. This systematic review included 32 cross-sectional studies that compared characteristics ascertained from lateral cephalograms or cone beam computed tomography (CBCT) in adults with and without OSA. Comprehensive searches were conducted in PubMed, Embase, and Web of Science from inception to December 2024. Meta-analyses revealed that the inter-first premolar distance (MD = −2.01, P < 0.00001), sella nasion plane length (SN, MD = −2.08, P < 0.00001), posterior airway space (PAS, MD = −1.95, P = 0.03) were notably smaller in the OSA group compared to controls. Conversely, anterior total facial height (ATFH, MD = 2.66, P < 0.0001), the soft palate length (UL, MD = 5.41, P < 0.00001) and the angle constituted by subspinale, nasion and supramentale (ANB, MD = 0.64, P = 0.01) were significantly larger in the OSA group. In comparison to healthy individuals, it is evident that OSA patients may present with a constricted maxillary arch, underdeveloped and clockwise-rotated mandible, augmented vertical facial growth, an inferiorly positioned hyoid bone, and a diminished pharyngeal airway space.