Radiographic findings predictive of obstructive sleep apnea in adults: A systematic review and meta-analysis
Sobhi Kazmouz, Nathan Calzadilla, Akriti Choudhary, Lander McGinn, Austin Seaman, Chad A. Purnell
Abstract
Polysomnography remains the diagnostic gold standard for obstructive sleep apnea (OSA), but it cannot be easily performed in a timely fashion within the practice of a craniomaxillofacial surgeon. Hence, in this systematic review and meta-analysis, we aimed to identify radiographic indicators that could predict obstructive sleep apnea (OSA) diagnosis. We conducted a PRISMA-compliant systematic review and meta-analysis, including 109 studies with 9817 participants (3509 controls, 6308 OSA patients), predominantly male (79% controls, 85% OSA patients). The analysis focused on CT (36, 33%), MRI (23, 21%), and lateral cephalogram findings (50, 46%). The average age and BMI for the included patients were 44.4 ± 14.4 years and 26.4 ± 5.2 kg/m 2 for controls, and 51.5 ± 40.4 years and 29.8 ± 6.4 kg/m 2 for the OSA group. A random-effects model meta-analysis was conducted on the measurements that met our criteria. Due to measurement differences between studies, only lateral cephalogram measurements could be included in the meta-analysis: OSA correlated with increased soft palate length and thickness, increased mandibular plane to hyoid bone distance, and decreased SNA, SNB, BaSN, SN distance, and palatal length (ANS-PNS). Although the study underscores radiographic utility for screening, PSG is necessary to establish a diagnosis of OSA.