Analysis of Palatal and Upper Airway Dimensions in Patients with Excessive Daytime Sleepiness: A Retrospective Cone-Beam Computed Tomography Study
Creators: name: Jarrett, Daniel
Publisher: name: University of Nevada, Las Vegas
Year: 2020
Subjects: subject: Dentistry
subject: FOS: Clinical medicine
subject: FOS: Clinical medicine

description: Excessive Daytime Sleepiness (EDS) is the measure of ones propensity to fall asleep during normal daily activities. It has been reported in 20%-50% of adults in the United States and is the most frequent symptom of patients presenting to sleep clinics. EDS is the result of both primary hypersomnias such as narcolepsy and idiopathic hypersomnia and, more commonly, secondary hypersomnias such as sleep deprivation, psychiatric conditions, medications, illegal substances, and obstructive sleep apnea (OSA).
The etiology of OSA is multifactorial. Collapsibility of the upper airway is influenced by both neuromuscular tone and craniofacial anatomy. Common predisposing factors for small airways include obesity, bony anatomical structures that reduce and impede the airway, and in children, oversized tonsils and adenoids. Maxillary dimensions have been shown to have a relationship with upper airway dimensions. Craniofacial growth and development relies on nasal breathing to produce a continuous pressure for the lateral growth of maxilla and for downward palatal growth, however, in mouth breathers this stimulus is lost and ultimately results in altered craniofacial growth that is observed extra-orally as long lower facial height (adenoid face), lip incompetence, and constricted alar base. Intraorally, the findings typically include a narrow maxillary arch associated with a deep palatal vault. Some studies have shown that patients presenting with a narrow maxilla also exhibit constricted nasopharyngeal dimensions and altered respiratory function and other studies showed that there is a strong relationship between airway obstruction and a high palatal vault.
Reducing the high number of undiagnosed patients with OSA ultimately relies on health care providers taking a multidisciplinary approach to screen for patients who exhibit the signs and symptoms of OSA and refer these patients for proper diagnosis and treatment. Orthodontists are trained to treat dental and facial skeletal discrepancies and, therefore, play a large role in identifying patients who have or may develop breathing problems. In 2019, the American Academy of Orthodontists released a White Paper regarding the role of orthodontists in the management of OSA and strongly suggested that orthodontists screen for OSA during an initial exam by assessing various risk factors such as body mass index, nasal obstruction, excessive daytime sleepiness and refer at-risk patients for diagnostic evaluation.
This study aimed at gaining a deeper understanding of some of the common risk factors for obstructive sleep apnea in order to help health care providers more accurately detect breathing disorders during a routine exam. Level of daytime sleepiness, palatal dimensions, airway dimensions, gender, age, ethnicity and body mass index from 253 patients were compared to corroborate and expand on the findings in the current literature. The data from this study showed significant differences between sleepiness and palatal width, sleepiness and ethnicity, age and airway dimensions, gender and palatal width and airway dimensions, ethnicity and palatal dimensions, body mass index and airway volume, and significant correlations between palatal depth and airway minimum cross-sectional area, palatal depth and airway volume, airway volume and airway minimum cross-sectional area. These findings showed both similarities and differences with the current literature. Future studies are needed to expand on these relationships and their importance in clinical applications for the identification of breathing related sleep disturbances.