Differences In Growth And Developement,craniofacial And Airway Morphology Between Children With Simple Snoring And Obstructive Sleep Apnea Hypopnea Syndrome

Objective: This article compares the differences of growth and development,craniomaxillofacial and upper airway morphology,as well as hyoid bone position in children with obstructive sleep apnea hypopnea syndrome(OSAHS)and primary snoring(PS)in order to analyze the risk factors in different degrees of sleep disordered breathing in children and argue whether the risk factors can develop a synergy,and thus to analyze the potential etiology of simple snoring and OSAHS in children through the morphology and oral structure.Methods: The subjects were patients aging from 4 to 14 who consulted a snoring specialist in Tangshan Union Medical College Hospital from September 2019 to December 2020.All the patients who met Inclusion and Exclusion Criteria were monitored for polysomnography and CBCT.The patients were divided into OSAHS group and PS group according to the diagnostic criteria of OSAHS for children published in The Third Edition of the International Classification of Sleep Disorders.The data collected from the two groups includes their height,their weight,sleep apnea hypopnea index(AHI),minimum arterial oxygen saturation(LSa O2),and dimensions of their craniofacial and upper airway.SPSS 25.0 was used to test the normality and homoscedasticity of the quantitative data collected from two groups,and Independent Sample t Test was used to compare the two groups of data.Linear correlation analysis and multiple linear stepwise regression analysis were used to evaluate the relationship between each measurement index,AHI,and LSa O2.Result:1.There were 81 patients who met Inclusion and Exclusion Criteria,including 33 patients in OSAHS group(22 males and 11 females),with an average age of 7.96 ± 2.55 years,and 48 patients in PS group(31 males and17 females),with an average age of 7.56 ± 2.59 years.There was no statistical difference in age and gender between the two groups(P>0.05).2.Difference in growth and development: the body mass index(BMI)of OSAHS group was higher than that of PS group(P<0.05),and there was no statistical difference in height and weight between the two groups(P>0.05).3.Differences in craniofacial structure: ANS-Me of OSAHS group was higher than that of PS group in vertical direction(P<0.01),and NP-FH of OSAHS group was lower than that of PS group in sagittal direction(P<0.05).There was no statistical difference in jaw sizes,teeth positions and other measurement indexes between the two groups(P>0.05).4.The differences in upper airway morphology and hyoid bone position:A,T,T/P of OSAHS group were higher than those of PS group(P<0.01);N and A/N were higher than those of PS group(P<0.05).The cross-sectional area of soft palate plane was smaller than those of PS group(P<0.01);the anteroposterior diameter of hard palate plane and the anteroposterior diameter of soft palate plane were smaller than those of PS group(P<0.05).There was no statistical difference in other measurement indexes between the two groups(P>0.05).In terms of hyoid bone,H-SN and H-FH of OSAHS group were higher than those of PS group in vertical position(P<0.05).There was no statistical difference in horizontal position between the two groups.5.Correlation analysis: NP-FH,H-SN,and H-FH were positively correlated with AHI.T and T/P were negatively correlated with LSa O2.There was no correlation between other indexes,AHI,and LSa O2(P>0.05).6.Stepwise regression analysis: When taking AHI as the dependent variable,NP-FH,H-SN,H-FH as the independent variables,only H-FH had statistical significance(adjusted OR= 0.219,P<0.01).When taking LSa O2 as dependent variable,T and T/P as independent variables,only T/P had statistical significance(adjusted OR= 0.228,P<0.01).Conclusion:1.Differences in growth and development between children with simple snoring and children with OSAHS were found.Obesity is a risk factor for children with OSAHS.2.Compared with children with simple snoring,the mandible of OSAHS children was retracted and rotated clockwise,and the lower facial height increased,in the shape of long facial forms.3.Compared with children with simple snoring,the adenoids and tonsils of OSAHS children were more hypertrophic.4.Compared with children with simple snoring,children with OSAHS had narrower airway at hard palate level and soft palate tip level.5.Compared with children with simple snoring,the hyoid bone position of OSAHS children is lower.6.The degree of mandible retrusion,hyoid bone position and tonsil hypertrophy plays a significant role in diagnosing and distinguishing the severity of OSAHS.The distance from the hyoid bone to Frankfort horizontal plane is an important factor affecting AHI,and the ratio of the thickness of the tonsil to the width of air way is an important factor affecting LSa O2.