Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions

Nathalia Carolina Fernandes Fagundes; Fabrizia d'Apuzzo; Letizia Perillo; Andreu Puigdollers; David Gozal; Daniel Graf; Giseon Heo; Carlos Flores-Mir

doi:10.5664/jcsm.9262

Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions

J Clin Sleep Med. 2021 Aug 1;17(8):1627-1634. doi: 10.5664/jcsm.9262.

Authors

Nathalia Carolina Fernandes Fagundes¹, Fabrizia d'Apuzzo², Letizia Perillo², Andreu Puigdollers³, David Gozal⁴, Daniel Graf¹, Giseon Heo¹, Carlos Flores-Mir¹

Affiliations

¹ School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
² Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Naples, Italy.
³ Department of Orthodontics and Craniofacial Orthopedics, Universitat Internacional de Catalunya, Barcelona, Spain.
⁴ Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri.

Abstract

Study objectives: To analyze differences in mandibular cortical width (MCW) among children diagnosed with obstructive sleep apnea (OSA) or at high- or low-risk for OSA.

Methods: A total of 161 children were assessed: 60 children with polysomnographically diagnosed OSA, 56 children presenting symptoms suggestive of high-risk for OSA, and 45 children at low risk for OSA. Children at high- and low-risk for OSA were evaluated through the Pediatric Sleep Questionnaire. MCW was calculated using ImageJ software from panoramic radiograph images available from all participants. Differences between MCW measurements in the 3 groups were evaluated using analysis of covariance and Bonferroni post-hoc tests, with age as a covariate. The association between MCW and specific cephalometric variables was assessed through regression analysis.

Results: The participants' mean age was 9.6 ± 3.1 years (59% male and 41% female). The mean body mass index z-score was 0.62 ± 1.3. The polysomnographically diagnosed OSA group presented smaller MCW than the group at low-risk for OSA (mean difference = -0.385 mm, P = .001), but no difference with the group at high-risk for OSA (polysomnographically diagnosed OSA vs high-risk OSA: P = .085). In addition, the MCW in the group at high-risk for the OSA was significantly smaller than the group at low-risk for the OSA (mean difference = -0.301 mm, P = .014). The cephalometric variables (Sella-Nasion-A point angle (SNA) and Frankfort - Mandibular Plane angle (FMA)) explained only 8% of the variance in MCW.

Conclusions: Reductions in MCW appear to be present among children with OSA or those at high-risk for OSA, suggesting potential interactions between mandibular bone development and/or homeostasis and pediatric OSA.

Citation: Fernandes Fagundes NC, d'Apuzzo F, Perillo L, et al. Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions. J Clin Sleep Med. 2021;17(8):1627-1634.

Keywords: child; cortical bone; mandible; sleep apnea syndromes.

MeSH terms

Body Mass Index
Cephalometry
Child
Female
Homeostasis
Humans
Male
Sleep Apnea, Obstructive* / diagnostic imaging
Software