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UBC Theses and Dissertations

Altered craniofacial morphology in children with OSAS : a clinical and photographic study Ayers, Evan


Introduction: With a reported prevalence of up to 5%, pediatric obstructive sleep apnea syndrome (OSAS) is a common childhood affliction. Consequences associated include growth delay, metabolic disturbance, impaired cognition, cardiovascular morbidity, and wake-time behaviour. Altered craniofacial morphology such as backwardly positioned jaws, small upper jaw/lower jaw ratios, and long narrow faces have been associated with pediatric OSAS. Standardized craniofacial digital photography is a readily available and safe imaging method that has been used in adult study populations; however, it has yet to be utilized in a pediatric population to assess its utility as a screening tool for OSAS. Objective: Utilizing a systematic clinical examination, the prevalence of altered craniofacial morphology in children referred for overnight polysomnography at BC Children’s Hospital will be assessed. Calibrated digital photographs will be analyzed to extrapolate any craniofacial findings associated with pediatric OSAS. Methods: Patients aged 4-16 were recruited at BCCH to participate, undergoing an extra-oral and intra-oral orthodontic exam, the taking of one frontal and one lateral photograph, and completion of a standardized sleep questionnaire by the Parent/Guardian. Results: 65 participants (29 female, 36 male, mean age 8.9 ± 3.1 years) were compared based on their AHI. 27 children had an AHI < 2/h (deemed not to have sleep apnea), 21 had mild OSAS (AHI 2 to 5/h), and 17 children were found to have severe OSAS (AHI >5/h). 19/65 participants (29.2%) were obese, and excluded from final analysis. Of the 44 remaining children, no significant differences were found for any direct clinical measurements between children with and without OSAS. Analysis of the standardized craniofacial photographs revealed that children with OSAS had a more obtuse cervicomental angle (7° increase), and an increase in lateral facial height (6 mm increase). An increasing cervicomental angle, intercanthal distance and cricomental distance were all correlated with the severity of OSAS. Conclusion: Aside from increases in cervicomental angle and lateral facial height, this study suggests altered craniofacial morphology may not be significantly associated with pediatric OSAS. Standardized craniofacial photography, in particular the measure of cervicomental angle, shows promise as a potential screening tool for OSAS, but requires further research.

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