Association Of Upper Airway Morphological Phenotypes With Obstructive Sleep Apnea In Middle-Aged Korean Adults

초록

Introduction: Obstructive sleep apnea (OSA) is a multifactorial disorder characterized by the recurrent collapse of the upper airway during sleep. It is commonly associated with obesity, enlarged pharyngeal soft tissues, and restricted craniofacial skeletal structures. The present study aims to investigate the relationship between (i) craniofacial morphology and (ii) volumetric measurements of the upper airway and surrounding soft tissues, and the prevalence of OSA in middle-aged Korean adults. Materials and methods: This cross-sectional study was conducted using data from a population-based cohort of Korean adults. A total of 89 participants (mean age: 61.65 ± 6.27 years; 50 males, 39 females) from the Korean Genome and Epidemiology Study in Ansan were included in the analysis. All participants underwent 1.5-Tesla MRI-based volumetric assessment of the upper airway (Magnetom Espree; Siemens Healthcare, Erlangen, Germany) and overnight in-home polysomnography (Embletta X-100; Embla Systems, Broomfield, CO, USA) between 2014 and 2015. Based on their apnea-hypopnea index (AHI), participants were categorized into two groups: no OSA (AHI <10 events/hour) and OSA (AHI ≥10 events/hour). Using Amira 5.4.0 image analysis software, a total of 23 volumetric measurements (airway and surrounding soft tissues) and 15 linear and angular cephalometric measurements were obtained from the upper airway MRI scans. Results: Based on multivariable linear regression analysis adjusted for age, sex, BMI, diabetes, and cardiovascular disease, several MRI-based volumetric and cephalometric features were significantly associated with the OSA group compared to the non-OSA group. Among the volumetric measurements, the OSA group exhibited a narrower anteroposterior dimension of both the retropalatal and retroglossal airways (β [SE] = -1.88 [0.66] (p=0.01); and -2.48 [0.95] (p=0.01), respectively), as well as a longer overall airway length (β [SE] = 3.69 [1.61], (p=0.02)). In terms of cephalometric characteristics, the OSA group showed a significantly greater maxillo-mandibular discrepancy and increased upper facial height compared to the non-OSA group (all p-values <0.05). Conclusions: This study identified distinct craniofacial and upper airway morphological features in individuals with OSA, including reduced anteroposterior airway dimensions and increased airway length. These findings emphasize the important role of upper airway phenotypes in the pathophysiology of OSA in middle-aged Korean adults. Acknowledgments: This study was supported by the Korea Centers for Disease Control and Prevention (2014-E71003-00, 2015-P71001-00); Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (NRF-2022R1I1A1A01065700); Korea Center for Gendered Innovations for Science and Technology research (GISTeR), through the Center for Women in Science, Engineering and Technology (WISET), funded by the Ministry of Science and ICT (WISET202503GI01).