TY - CHAP
T1 - Hyoid position correlates with respiratory events and pulmonary function in obstructive sleep apnea patients.
AU - Fetoni, Anna Rita
AU - Scarano, Emanuele
AU - Cadoni, Gabriella
AU - Mormile, Flaminio
AU - Sposi, A.
AU - Salvia, F.
AU - Maurizi, M.
PY - 2003
Y1 - 2003
N2 - A detailed cephalometric analysis was performed studied in the 66 obstructive sleep apnea patients and in 11 control subjects. The hyoid bone was found to be caudally displaced
in the apnea patients compared to the control group, with a highly significant
greater distance from the anterior nasal spine to the hyoid (H-ANS) from the
second cervical vertebrae to the hyoid (H-C2), and from the nasion to hyoid
(H-N), with smaller C2-H-N and C2-H-ANS angles even after exclusion of the
26 most obese subjects (BMI>27.9).
On multiple regression analysis, after adjustment for age and BMI, increased
H-C2 distance predicted (a) more severe nocturnal and daytime hypoxia (F =
12.4 and F = 7.4, with p < 0.01) and (b) lower values of FVC and FEV1
(percentage predicted; F = 30.5 and F = 21.6, with p < 0.01). IE50, an index of
sleep-related inspiratory airflow limitation, showed a negative correlation with
H-Gn (F = 17.1, with p < 0.01). These indexes did not predict AHIO in our
study.
Discussion
Skeletal craniofacial and soft tissue abnormalities of the upper airways have
been frequently reported in patients with OSA.3,4,6-8 These abnormalities predispose patients to pharyngeal occlusion and are related to the severity of OSA.5,6
One of the most studied types of cephalometric data in OSA patients is the low
position of the hyoid bone.3,6,9,10 The position of the hyoid bone is limited by
vertebral development and should be at the C3-C4 level by three years of age,
and at C4 by adulthood.4,9 However, there is an abnormally low hyoid position
in OSA patients. Usually, in cephalometric measurements, the position of the
hyoid bone is calculated with respect to the anterior nasal spine and the gnathion.
Instead, we found a highly statistically significant increase in the distance between the hyoid bone and the second cervical vertebrae (H-C2), which is considered to be a less variable anatomical parameter than other cephalometric
points.
The increased H-C2 distance retained a statistically significant value role
even after the exclusion of the most obese subjects. This suggests that a low hyoid
position may be considered to be a marker of airflow limitation in OSA patients, which is not otherwise explained by age or BMI. Moreover, our results
seem to confirm that palatal surgery alone may not be adequate for the treatment of OSA.
AB - A detailed cephalometric analysis was performed studied in the 66 obstructive sleep apnea patients and in 11 control subjects. The hyoid bone was found to be caudally displaced
in the apnea patients compared to the control group, with a highly significant
greater distance from the anterior nasal spine to the hyoid (H-ANS) from the
second cervical vertebrae to the hyoid (H-C2), and from the nasion to hyoid
(H-N), with smaller C2-H-N and C2-H-ANS angles even after exclusion of the
26 most obese subjects (BMI>27.9).
On multiple regression analysis, after adjustment for age and BMI, increased
H-C2 distance predicted (a) more severe nocturnal and daytime hypoxia (F =
12.4 and F = 7.4, with p < 0.01) and (b) lower values of FVC and FEV1
(percentage predicted; F = 30.5 and F = 21.6, with p < 0.01). IE50, an index of
sleep-related inspiratory airflow limitation, showed a negative correlation with
H-Gn (F = 17.1, with p < 0.01). These indexes did not predict AHIO in our
study.
Discussion
Skeletal craniofacial and soft tissue abnormalities of the upper airways have
been frequently reported in patients with OSA.3,4,6-8 These abnormalities predispose patients to pharyngeal occlusion and are related to the severity of OSA.5,6
One of the most studied types of cephalometric data in OSA patients is the low
position of the hyoid bone.3,6,9,10 The position of the hyoid bone is limited by
vertebral development and should be at the C3-C4 level by three years of age,
and at C4 by adulthood.4,9 However, there is an abnormally low hyoid position
in OSA patients. Usually, in cephalometric measurements, the position of the
hyoid bone is calculated with respect to the anterior nasal spine and the gnathion.
Instead, we found a highly statistically significant increase in the distance between the hyoid bone and the second cervical vertebrae (H-C2), which is considered to be a less variable anatomical parameter than other cephalometric
points.
The increased H-C2 distance retained a statistically significant value role
even after the exclusion of the most obese subjects. This suggests that a low hyoid
position may be considered to be a marker of airflow limitation in OSA patients, which is not otherwise explained by age or BMI. Moreover, our results
seem to confirm that palatal surgery alone may not be adequate for the treatment of OSA.
KW - apnea-hyponea index
KW - hyoid bone
KW - lung function test
KW - obstructive sleep apnea
KW - apnea-hyponea index
KW - hyoid bone
KW - lung function test
KW - obstructive sleep apnea
UR - http://hdl.handle.net/10807/166373
M3 - Chapter
SN - 90 6299 182 3
SP - 517
EP - 520
BT - In Surgery for snoring and obstructive sleep apnea
ER -