ASSOCIATION BETWEEN CRANIOFACIAL MORPHOLOGY AND SEVERITY OF OBSTRUCTIVE SLEEP APNEA IN KOREAN MIDDLE-AGED POPULATION: THE KOREAN GENOME AND EPIDEMIOLOGY STUDY

초록

Introduction: Obstructive sleep apnea (OSA) is a multifactorial disease defined by recurring collapse of the upper airway during sleep that is caused by obesity, enlarged pharyngeal soft tissues and restricted craniofacial skeletal structures. This study aims to investigate the association of craniofacial morphology and severity of OSA (including positional OSA) in a population sample from Korea. Materials and Methods: A total of 1,388 participants of the Korean Genome and Epidemiology Study, who collected both 2-D face photographs (frontal and profile views) and in-home polysomnography, were analyzed. Participants were classified into three groups based on the apnea–hypopnea index (AHI): no OSA (AHI<5 events/h), mild OSA (AHI 5–14.9 events/h), and moderate-to-severe OSA (AHI≥15 events/h). Positional OSA was defined as an AHI that was at least twice as high in the supine position than in the non-supine position when the AHI was ≥5 events/h. A total of 23 craniofacial features (including linear distance, angles and ratios) were measured in five categories: mandible, maxilla relationship, face, nose and eyes, and neck. Results: Based on multinomial logistic regression analysis adjusted for age, sex, height, and neck circumference, multiple craniofacial features were associated with moderate-to-severe OSA, including the highest tertile of mandibular width (OR [95% CI] = 2.51 [1.53-4.10]), face width (1.84 [1.16-2.93]) and cervicomental angle (2.42 [1.50-3.90]), compared to the lowest tertile of each craniofacial features. In addition, smaller mandibular length/width ratio was associated with OSA severity (2.89 [1.86-4.49]). Meanwhile, larger mandibular width, face width and cervicomental angle and smaller mandibular length/width ratio and face width/height ratio were associated with positional OSA (all p <0.02). Conclusions: In the present study, we found that multiple craniofacial features are independently associated with severity of OSA and/or positional OSA in the Korean population.