Title Lateral Cephalometric Measurements Aid in Diagnosing Obstructive Sleep Apnea (OSA)
Clinical Question In adult and adolescent patients, will lateral cephalometric measurements compared to polysomnography provide enough information for OSA diagnosis?
Clinical Bottom Line Lateral cephalometric measurements can help identify patients who may benefit from OSA screening. This is supported by two systematic reviews. The first showed that OSA patients, compared to the control groups, have higher total anterior lower face height (ALFH), reduced posterior airway space (PAS), and inferior position of the hyoid bone related to the mandible (MP-H). The second study, a meta-analysis, supported the findings of OSA patients having lower hyoid bones and smaller posterior airway space than the controls.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
27039222Neelapu/201625 studiesMeta-Analysis
Key resultsOSA patients compared to control subjects have a significantly higher total anterior lower face ALFH (weighted mean difference [WMD] = 2.48 mm), reduced MP-H (WMD = 7.22 mm) and reduced PAS (WMD = 5.45 mm).
26234535Armalaite/201611 studiesMeta-Analysis
Key resultsMP-H in OSA patients compared to controls is was found to be higher by 4.14 mm (95% confidence interval [CI], 3.52 to 4.75). Upper PAS in OSA patients compared to controls is was found to be -4.53 mm (95% CI, -6.28 to -2.77).
Evidence Search OSA[All Fields] AND "Cephalometry"[Mesh] AND ("sensitivity and specificity"[MeSH Terms] OR ("sensitivity"[All Fields] AND "specificity"[All Fields]) OR "sensitivity and specificity"[All Fields] OR "sensitivity"[All Fields])) AND "Diagnosis"[Mesh]
Comments on
The Evidence
Validity: Both of these studies are meta-analyses, the highest in the hierarchy of evidence, and both showed that OSA patients have certain craniofacial morphology characteristics that differentiate them from controls. The first study was valid because it used a comprehensive search of the available information, had adequate selection criteria, included 25 studies, and had more than one reviewer. The limitations were that the study didn’t have comparisons between different racial groups, and some of the studies were not age and sex matched. The second study found a relationship only with increased MP-H and reduced upper posterior airway space. They did not find a relationship between anterior facial height and OSA, as the first study did. Also of note, the two studies looked at different areas of the posterior airway space. Perspective: Lateral cephalometry be useful, but there is no evidence that it can be used for a definitive diagnosis. Moreover, lateral cephalometry only gives 2D information as opposed to the 3D information obtained from a cone beam CT study. Also, lateral cephalograms might contain magnification errors as a result of different machines being used. On the other hand, polysomnography (PSG) is expensive and time consuming, which may limit the number of patients that are referred for it. Further prospective investigations are needed to identify which, if any, cephalometric measurements can help identify those patients who may benefit from further OSA screening. These should include more randomized clinical trials and cone beam CT studies.
Applicability The gold-standard for diagnosing OSA is polysomnography; however, it is an expensive procedure that takes time and would not be productive for every screening patient. Cephalometric radiographs are part of the primary standard of care regarding screening records taken in orthodontic practices. It would be beneficial if these records could be used as a first test to help determine if a patient should be sent for further examination such as PSG.
Specialty (Oral Medicine/Pathology/Radiology) (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords OSA, Polysomnography, Lateral Cephalometry, Diagnosis
ID# 3104
Date of submission 11/06/2016
E-mail zambranomart@uthscsa.edu
Author Catalina Zambrano Martinez, DDS
Co-author(s) e-mail
Faculty mentor Ann Larsen DDS, MS
Faculty mentor e-mail larsena@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available