3D Upper Airway Analysis of Skeletal Class I, II, and III Adults with High or Low Risk for Excessive Daytime Sleepiness
Creators: name: Dao, Alexander
Publisher: name: University of Nevada, Las Vegas
Year: 2020
Subjects: subject: Dentistry
subject: FOS: Clinical medicine
subject: FOS: Clinical medicine

description: Objective: To investigate the differences in ethnicity, BMI, sex, total airway volume, minimum cross-sectional area, airway shape, and hyoid bone position in high risk for excessive daytime sleepiness vs low risk for excessive daytime sleepiness in skeletal class I, II, and III patients
Introduction: Obstructive Sleep Apnea (OSA) is an underdiagnosed medical condition with many negative consequences on a patients overall health (Dempsey, J.A., Veasey, S.C., Morgan, B.J., & ODonnell, 2010). OSA is defined as the occurrence of at least 5 instances per hour of sleep during which breathing temporarily stops (Motamedi, McClary, & Amedee, 2009). Undiagnosed OSA could lead to severe consequences ranging from depression, excessive daytime sleepiness to more severe conditions such as hypertension and even death (Dempsey, J.A., Veasey, S.C., Morgan, B.J., & ODonnell, 2010). It is believed that 85% of patients deal with OSA symptoms daily but go undiagnosed (Motamedi et al., 2009).
Several risk factors place patients at increased risk for OSA such as craniofacial anatomy (i.e. position of mandible, small mandibles, abnormal soft palate, and size of tonsils) and medical conditions (i.e. diabetes, HTN). Furthermore, OSA involves constriction of the upper airway and past research analyzing OSA confirm an association between small upper airway dimensions and OSA (Ogawa, Enciso, Shintaku, & Clark, 2007). Additionally, Iwasaki et al. reported that skeletal class II patients with retrognathic mandibles have reduced airway dimensions and Class III patients may have same airway volume as or larger than Class I cases (Iwasaki, Hayasaki, Takemoto, Kanomi, & Yamasaki, 2009). Lastly, there are studies that show daytime sleepiness as a symptom of patients who have OSA (Motamedi et al., 2009).
OSA is a condition with morbid symptoms that affects a large percentage of the population but often goes unnoticed. This project investigates the associations between patients ethnicity, BMI, sex, total airway volume, minimum cross-sectional area, airway shape, and hyoid in skeletal class I, II, and III individuals with high or low risk for excessive daytime sleepiness.
Methods: Patients sex, ethnicity, and BMI data in patient records of UNLV Dental School of Medicine were collected. Patients cephalometric radiographs were viewed in Dolphin Imaging to determine a patients skeletal classification via cephalometric analysis utilizing racial and sex specific norms. Furthermore, it involved utilizing Invivo Anatomage to calculate the total airway volume, minimum cross section area, and airway shape of each patient. Chi Square, Independent Samples T-Test, One Way Anova, and Kruskal-Wallis H test was used to investigate any statistically significant differences in a patients ethnicity, BMI, sex, total airway volume, minimum cross section area, airway shape at the minimum cross-sectional area and hyoid bone position of skeletal class I, II, and III patients with low or high risk for EDS.
Results: No significant differences between ethnicity, BMI category, sex, total airway volume, minimum cross-sectional area, airway shape at the minimum cross-sectional area, and hyoid bone position between high vs low risk for excessive daytime sleepiness patients. Furthermore, our study showed no differences for the same variables mentioned above when compared between skeletal Class I, II, and III. Lastly, when comparing the same variables mentioned above for a combined group of different combinations of risks for sleepiness and skeletal classification groups, there were no statistically significant differences for all measures except for ethnicity. The differences in ethnicities among combined groups for risk for sleepiness and skeletal classification was significant.
Conclusion: We conclude that there is no relationship between BMI category, sex, total airway volume, minimum cross-sectional area, airway shape, and hyoid bone position between skeletal class I, II, and III patients with different risks for excessive daytime sleepiness among adult UNLV orthodontic patients. However, ethnicity does play a role between the different combined groups for risk for excessive sleepiness and skeletal classification. More studies need to be done to see if the same conclusions apply to the entire population of skeletal class I, II, and III with high or low risk for excessive daytime sleepiness.