Relating three‐dimensional airway measurements to the apnea‐hypopnea index in pediatric sleep apnea patients

• Published in: Orthodontics & craniofacial research Vol. 24; no. 1; pp. 137 - 146
• Main Authors: Masoud, Ahmed I., Alwadei, Abdurahman H., Gowharji, Lena F., Park, Chang G., Carley, David W.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2021
• Subjects: adenoids; Adolescent; Adult; Aged; airway; Apnea; breathing; CBCT; Child; Children; Computed tomography; Dentistry; Humans; Oropharynx; OSA; Pediatrics; Polysomnography; Respiratory tract; ROC Curve; Sleep; Sleep apnea; Sleep Apnea Syndromes - diagnostic imaging; Sleep Apnea, Obstructive - diagnostic imaging; Sleep disorders; Snoring; Sleep; breathing; airway; adenoids; OSA; CBCT; Snoring
• ISSN: 1601-6335; 1601-6343
• DOI: 10.1111/ocr.12417

Objectives (a) To evaluate three‐dimensional radiographic airway analysis as it relates to the pre‐test probability for sleep apnea in pediatric patients, and (b) to develop cut‐off values for measurements showing promising results. Setting and Sample Population A consecutive series of pediatric patients between the ages of 7 and 17 years, referred for a sleep study were recruited. Cone beam computed tomography (CBCT) scans were acquired for 103 subjects within one month following the sleep study. Methods Three‐dimensional airway analysis was performed including volumetric, area and linear measurements. Correlations with the apnea‐hypopnea index (AHI) and receiver operating characteristic (ROC) curves were constructed. Sensitivity and specificity were calculated for prediction of AHI ≥ 5 and AHI ≥ 10. Results 99 CBCT scans were included (median age = 11 years). The nasopharyngeal volume (NPV) significantly correlated with AHI (rho≈‐0.4, P < .05). In subjects aged 7‐11 years, proposed cut‐off values for NPV are 2400mm3 and 1600mm3 for AHI ≥ 5 and AHI ≥ 10, respectively. In subjects aged 12‐17 years, proposed cut‐off values for NPV are 3500mm3 and 2700mm3 for AHI ≥ 5 and AHI ≥ 10, respectively. Oropharyngeal cross‐sectional area (OCSA) demonstrated significant predictive value in ROC curve analysis, and cut‐off values for this airway measure are also proposed. Conclusions Contrary to findings in adults, the NPV shows promise when screening for sleep apnea in children when CBCT scans are available. The OCSA might also be of value when screening for sleep apnea especially in older children.