Risk Factors For Craniomaxillofacial,Hoyoid And Upper Airway In Children With Obstructive Sleep Apnea-hypopnea Syndrome

Objective:The aim of this study was to investigate the two-dimensional and three-dimensional differences in cranio-maxillofacial,hyoid and airway morphology between children with obstructive sleep apnea hypopnea syndrome and normal children,and to analyze the maxillofacial risk factors of OSAHS in children.Methods:The study is a case-control study.A total of 31 pediatric OSAHS patients confirmed by polysomnography（PSG）were included as the case group and 31 children without sleep apnea as the control group.The patients and controls were strictly matched by age and sex.Cone beam computed tomography was used to measure and compare the two groups of children’s craniofacial,hyoid and airway structures.Results:1. Craniomaxillofacial morphology:In vertical direction,SN-FH and MP-SN in OSAHS group were significantly greater than those in control group（P<0.01）,PP-FH in OSAHS group were significantly smaller（P<0.05）.In sagittal direction,SNB in OSAHS group was significantly smaller than that in control group（P<0.01）,ANB in OSAHS group were significantly greater than those in control group（P<0.01）.There was no significant difference between the two groups in maxillary and mandible dimension、dental measurement items and other measurement items（P>0.05）.2. Hyoid position and upper airway:In the horizontal position of hyoid,H-RGn in OSAHS group was greater than that in the control group（P<0.05）.In the vertical position of hyoid,H-MP,H-SN and H-C3Me in OSAHS group were greater than that in the control group（P<0.01）.In terms of upper airway,A and A/N in OSAHS group were greater than that in the control group（P<0.01）.SPP-SPPW,PNS-AD1,PNS-AD2,the anteroposterior dimension,lateral dimension and the cross-sectional area of the upper airway in the hard palate plane were significantly smaller in the in the OSAHS patients（P<0.05）.There was no significant difference in other measurement items between the two groups（P>0.05）.3. Correlation analysis:SNB,PNS-AD1 and lateral dimension of the upper airway in the hard palate plane were negatively correlated with AHI.ANB,H-C3Me,A and A/N were positively correlated with AHI（P<0.05）.There was a positive correlation between SNB and LSa O₂ and positive correlation between SNA,H-C3Me and LSa O₂（P<0.05）.There was no statistical significance in other indexes（P>0.05）4. Stepwise regression analysis:We performed stepwise regression analysis with AHI as the dependent variable,SNB,ANB,A,A/N,H-C3Me and lateral dimension of the upper airway in the hard palate plane as independent variables.Only H-C3Me was statistically significant（adjusted OR=0.68,P<0.01）Conclusions:1.Children with OSAHS the anticlockwise rotation of the anterior skull base plane,clockwise rotation of the mandibular plane and mandibular retrognathia.2.Children OSAHS patients are manifested as adenoidal hypertrophy and the most prominent part of the soft palate and the hard palate plane at the upper airway stenosis.In children with OSAHS,the hyoid bone appears to be in a significantly retrograde and inferior position.3.The two-dimensional and three-dimensional indexes of CBCT in children with OSAHS can provide some reference for the prediction of the severity of OSAHS.The degree of mandibular retrusion,the distance from hyoid bone to the line between the third cervical vertebra and submental point,the degree of adenoid hypertrophy and lateral dimension of the upper airway in the hard palate plane are all significant for the diagnosis of the disease.The distance between hyoid bone and the third cervical vertebra and submental point may be an important factor affecting AHI.