Aims Obstructive sleep apnoea (OSA) is considered as a major healthcare problem, remaining relatively underdiagnosed and associated with significant comorbidity (Rejón-Parrilla et al., 2014). The present study aims to explore: the existence of a craniofacial phenotype in adults with OSA, the ability to predict the condition from clinical and surface craniofacial structures and the presence of a surface facial marker for OSA.
Methods A case-control study was conducted with 118 middle-aged Caucasian males (56 controls; 62 OSA). Each undergoing a clinical examination including body mass index, Mallampati airway classification, sleep apnoea clinical score, Epworth sleepiness scale and 3-D stereophotography for surface craniofacial analysis (figure1).
Results Surface craniofacial risk factors (phenotype) were identified for OSA Caucasian males, with the predominant characteristics being: an enlarged neck circumference (p<0.001), short neck (p<0.001), large mandibular width (p<0.001), forward head posture (p<0.001) and increased lower anterior facial height (P<0.002). Multiple regression analysis for the surface predictors, both with and without clinical variables, identified a range of prediction models with moderate to high sensitivity and specificity, with an area under the receiver operating characteristics curve (AUC) between 0.73–0.82. A higher positive and lower negative likelihood-ratios were identified for the combination model of the surface and clinical variables (LR+6.02, LR–0.40 respectively) when compared to the surface model alone. A high positive post-test probability and odds ratio (87%, OR=6.8, respectively) were also identified in the combination model. The surface model, with and without clinical variables, not only successfully identified OSA subjects from controls (AUC=0.77, 0.82 respectively) but also presented as a marker (figure 2).
Conclusion This case-control study demonstrated the existence of a surface craniofacial phenotypic pattern, identified a predictive model and marker for OSA in Caucasian males, using 3D-surface imaging analysis and clinical tools.
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