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Craniofacial features of obese obstructive sleep apnea (OSA) patients in relation to the obesity onset Al Furiji, Samah Nasser


Objectives: Obstructive Sleep Apnea prevalence is substantially higher in men and subjects with higher body mass indexed. OSA is present in 41% of individuals with a BMI>28 kg/m², and in up to 78% in morbidly obese patients. Obesity alone is not the sole cause of OSA and craniofacial morphology is also a key determinant of the predisposition to airway collapse. There is still controversial data on the craniofacial characteristics of obese OSA patients and we hypothesize that the age when individuals become obese, can affect the craniofacial features of obese OSA patients. Methods: The prospective sample consisted of 39 obese and 43 non-obese OSA adults matched for age and OSA severity from a retrospective cohort. The age of obesity onset was determined through a questionnaire and diagnosis of craniofacial and airway morphology was made from standard cephalometric radiographs. Result: Twelve early obese, 21 late obese and 29 non-obese OSA patients were deemed eligible for this study. The mean age was 45.6, 50.9 and 48.1 years for early, late and non-obese groups, respectively. Non-obese OSA, compared to obese subjects, showed a significantly more retrognathic mandible, larger maxillo-mandibular discrepancy, shorter lower facial height, deeper overbite, less upper incisors proclination and protrusion, longer soft palate, higher position of hyoid bone, narrower inferior airway space, longer airway length and less obtuse head posture. The early obesity group, compared to non-obese, showed a prognathic mandible, longer lower facial height, more proclined upper incisors, caudally positioned hyoid bone, wider inferior airway space and shorter airway length. The late obesity group, compared to non-obese group, showed a proclined and protrusive upper incisors, shallower overbite, inferiorly positioned hyoid bone, shorter airway length and obtuse cranio-cervical angle. There was no significant difference between early and late obesity groups. Conclusion: Obese OSA patients have more developed craniofacial skeletons with less bony and airway constriction than their non-obese counterparts; and early and late obesity groups showed discrepancies in their characteristics which were different from non-obese subjects, suggesting a possible impact of obesity onset on craniofacial characteristics. Further studies are still needed to determine the effect of obesity onset on craniofacial development.

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