Title CBCT Airway Analysis Can Provide Reliable Information About Obstructive Sleep Apnea but Should Not Be Considered a Diagnostic Measure
Clinical Question Is 3D airway volumetric analysis of cone beam computed tomography (CBCT) images a reliable diagnostic method to detect obstructive sleep apnea?
Clinical Bottom Line High-level evidence shows that CBCT can be used as a reliable method to evaluate narrowing of the upper airway. However, based on the current literature, there is no evidence to support the diagnostic reliability of CBCT for obstructive sleep apnea, and it should not be used mainly for this purpose.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
27999121Zimmerman/201642 studies/956 patientsSystematic review of non-randomized trials
Key resultsThree high-quality studies assessed both intra- and inter-examiner reliability. These studies showed good intra- and inter-examiner reliability for volume analysis with kappa values of 0.981-0.999 and 0.986-0.998, respectively. Furthermore, moderate intra- and inter-examiner reliability was detected for minimum cross-sectional area with values of 0.780-0.937 and 0.839-0.876, respectively. Additionally, higher reliability was found toward the airway volume analysis than minimum cross-sectional area.
27448467Chen/20168 articles Systematic review of non-randomized trials
Key resultsPatients with obstructive sleep apnea show significantly smaller minimum cross-sectional area of the upper airway compared to non-OSA patients [“significant difference between obstructive sleep apnea patients and control subjects, P < 0.05”].
Evidence Search ("cone beam computed tomography"[MeSH Terms] OR ("cone beam"[All Fields] AND "computed"[All Fields] AND "tomography"[All Fields]) OR "cone beam computed tomography"[All Fields] OR ("cone"[All Fields] AND "beam"[All Fields] AND "computed"[All Fields] AND "tomography"[All Fields]) OR "cone beam computed tomography"[All Fields]) AND (("airway"[All Fields] OR "airway s"[All Fields] OR "airways"[All Fields]) AND ("analysis"[MeSH Subheading] OR "analysis"[All Fields])) AND ("sleep apnoea"[All Fields] OR "sleep apnea syndromes"[MeSH Terms] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "syndromes"[All Fields]) OR "sleep apnea syndromes"[All Fields] OR ("sleep"[All Fields] AND "apnea"[All Fields]) OR "sleep apnea"[All Fields])
Comments on
The Evidence
Validity: Zimmerman et al: a systematic review of eligible 42 articles chosen from total of 1241 articles collected from MEDLINE, EMBASE, AND Web of science. The reliability of upper pharyngeal airway analysis was performed for 956 patients in the chosen studies. Wide range of variation in methodologies and results were discovered between the studies. Large heterogeneity was found between the selected studies; therefore, meta-analysis was not performed. Additionally, these studies depended mostly on objective protocols to perform, analyze, and interpret the measurements. Chen et al: after electronic search of the database (MEDLINE, EMBASE, Web of Science, and Cochrane library), 8 out of 758 articles were selected for the systematic review after applying all the inclusion criteria. The selected studies were used to compare upper airways measurements for people with and without OSA. The selected studies performed multiple analysis on multiple 3D imaging modalities. Large heterogeneity was found between individual studies hence meta-analysis was not performed. Perspective: all the primary studies in both systematic reviews show wide range of variation in the methodology, measurements, and quality without clear protocols or standards. Although both systematic reviews indicate that narrowing and reduced minimal cross-sectional area of the upper airway might be indicative of obstructive sleep apnea, the narrowing can be due to multiple variables, such as patient and tongue position. If standard protocols are set, CBCT measurements combined with clinical findings could provide diagnostic information for the upper airway.
Applicability One of the major features of the obstructive sleep apnea is narrowing of the upper airway, which can be evaluated using CBCT. This assessment can help in screening the airway for obstructive conditions, such as sleep apnea. 3D airway analysis shows that patients with OSA have significantly smaller oropharyngeal cross sectional areas. However, since there are no standardized protocols and based on the current literature and ALARA, CBCT should not be performed for the purpose of the diagnosis of obstructive sleep apnea.
Specialty (Oral Medicine/Pathology/Radiology) (Oral Surgery) (Orthodontics) (Pediatric Dentistry)
Keywords Cone-beam computed tomography; sleep apnea; obstructive airway
ID# 3443
Date of submission 11/24/2020
E-mail Khubrani@Livemail.uthscsa.edu
Author Yahia Khubrani
Co-author(s) Nikolaos Shinas
Co-author(s) e-mail shinas@livemail.uthscsa.edu
Faculty mentor Dr. Hassem Geha
Faculty mentor e-mail Geha@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
by Mina Morcos (San Antonio, Texas) on 11/06/2022
Could CBCT rule out other variables that might be a cause for narrowing the airway, providing a more solid evidence for sleep apnea?