Does three-dimensional facial morphology relate to risk of sleep-disordered breathing in children? A cross-sectional study.

ObjectiveTo assess the feasibility of three-dimensional (3D) stereophotogrammetry as a tool in pediatric outpatient assessment, in exploring associations between facial morphometric parameters of children aged 2-17 years, and their risk of sleep-disordered breathing (SDB) as evidenced by their Pediatric Sleep Questionnaire (PSQ) score.MethodsA cross-sectional study of 180 pediatric patients (aged 2-17 years) recruited consecutively from a tertiary pediatric otolaryngology clinic. 3D facial images were acquired using stereophotogrammetry, and patients' SDB risk was evaluated using the validated PSQ. Linear regression models assessed associations between PSQ scores and demographic and facial morphometric variables. Geometric morphometric (GMM) analysis was performed to assess differences in facial morphology between subjects at high and low risk for SDB.Results33.9% of patients scored at high risk for SDB. No statistically significant associations were found between PSQ score and any 3D facial morphometric parameter. PSQ score was not associated with sex, age, age×sex interaction, or body mass index. Geometric morphometric analysis found no difference in facial shape between those at high risk for SDB and those at lower risk.ConclusionsStereophotogrammetry may be successfully applied in a specialist pediatric outpatient clinic as a non-invasive and low-resource method for measuring 3D facial features. No linear or angular measurements assessed in this study were found to have a strong correlation with PSQ score. These findings suggest that 3D external facial soft-tissue measures may not add discriminatory value beyond symptom-based screening in this tertiary clinic setting, and that facial morphology alone is unlikely to be a sufficient screening tool for pediatric SDB. Screening should primarily be based on patient signs and symptoms, and consideration of internal anatomical factors.