Nature and science of sleep · 2026
Utility of Cephalometry and Acoustic Pharyngometry for the Assessment of Moderate to Severe Obstructive Sleep Apnea Before Treatment in Childhood.
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Bokov Plamen, Dudoignon Benjamin, Baydoun Amina, Dahan Jacques, Amat Philippe, Sghaier Fayrouz, Boujemla Imene, Bonnet Anne-Laure, Delclaux Christophe
Аннотация
PURPOSE: The ERS Statement dealing with childhood obstructive sleep apnea (OSA) declared that cephalometry and acoustic pharyngometry may be useful exams for the management of OSA. The objective of our cross-sectional study was to evaluate the correlations between the severity of OSA, namely obstructive apnea-hypopnea index (OAHI), and indices obtained from both acoustic pharyngometry and cephalometry in children referred for OSA treatment.
METHODS: Children referred for treatment of their moderate to severe OSA (AHI ≥ 5/hour) underwent acoustic pharyngometry in sitting and supine positions (measurement of pharyngeal volume and calculation of estimated pharyngeal compliance) and cephalometry (measurement of Frankfort Mandibular plane Angle: FMA and Frankfort Mandibular Incisal Angle: FMIA, hyoid bone distance to mandibular plane).
RESULTS: Two hundred and five consecutive children were enrolled (mean age ± SD: 11.2 ± 3.7 years, 73 females, type 1 OSA "enlarged tonsils": 55 children, type 2 "obese": 80, type 3 "syndromes": 70). In a multiple regression analysis, only FMA and hyoid bone distance remained independently linked to OAHI (adjusted r2 of the model: 0.12, p< 0.001, weak explanatory power). The FMA angle allowed differentiating normodivergence (21°< FMA < 29°: 41% of the children), hyperdivergence (FMA ≥ 29°: 32%), and hypodivergence (≤ 21: 27%). The participants with hyperdivergence were younger, less obese, and had a longer lower face (adenoid facies). In a multiple regression analysis, only height and FMIA remained independently linked to pharyngeal volume (adjusted r2 of the model: 0.32, p<0.001, moderate explanatory power).
CONCLUSION: Childhood OSA can be associated with hypodivergence. Its severity is linked to craniofacial morphology, and cephalometry provides additional endotypic information in selected children.
METHODS: Children referred for treatment of their moderate to severe OSA (AHI ≥ 5/hour) underwent acoustic pharyngometry in sitting and supine positions (measurement of pharyngeal volume and calculation of estimated pharyngeal compliance) and cephalometry (measurement of Frankfort Mandibular plane Angle: FMA and Frankfort Mandibular Incisal Angle: FMIA, hyoid bone distance to mandibular plane).
RESULTS: Two hundred and five consecutive children were enrolled (mean age ± SD: 11.2 ± 3.7 years, 73 females, type 1 OSA "enlarged tonsils": 55 children, type 2 "obese": 80, type 3 "syndromes": 70). In a multiple regression analysis, only FMA and hyoid bone distance remained independently linked to OAHI (adjusted r2 of the model: 0.12, p< 0.001, weak explanatory power). The FMA angle allowed differentiating normodivergence (21°< FMA < 29°: 41% of the children), hyperdivergence (FMA ≥ 29°: 32%), and hypodivergence (≤ 21: 27%). The participants with hyperdivergence were younger, less obese, and had a longer lower face (adenoid facies). In a multiple regression analysis, only height and FMIA remained independently linked to pharyngeal volume (adjusted r2 of the model: 0.32, p<0.001, moderate explanatory power).
CONCLUSION: Childhood OSA can be associated with hypodivergence. Its severity is linked to craniofacial morphology, and cephalometry provides additional endotypic information in selected children.