(1304) Association of Craniofacial Dimensions with Upper Airway Collapsibility in Patients with Obstructive Sleep Apnea

Introduction: This study examines the association between craniofacial skeletal dimensions and objective measures of upper airway collapsibility obtained using drug-induced sleep endoscopy with positive airway pressure (DISE-PAP), with the goal of identifying anatomical predictors that may inform surgical decision-making in patients with OSA.

Methods: This is a retrospective cohort study performed at a tertiary care center consisting of adult patients with OSA who underwent drug-induced sleep endoscopy with positive airway pressure (DISE-PAP). The primary outcome measure was pharyngeal opening pressure (PhOP), representing the pressure required to resolve upper airway collapse. Independent variables included craniofacial skeletal dimensions derived from 3D imaging software, along with relevant demographic and clinical features. Preliminary analyses assessed associations between skeletal measurements and PhOP using descriptive statistics and correlation testing.

Results: Of the 211 patients included in the study, 75% were male, 66% White, most were middle-aged (55.3 ± 14.6 years) with average BMI 30.1 ± 4.5. The average AHI 3% was 35.2 ± 26.05 events/hour. The average PhOP was 8.22 ± 3.41 cm H2O. Maxillary hypoplasia and retrognathia measured via SNA and SNB were weakly correlated with PhOP (r = 0.15 and 0.15, respectively, p-value < 0.05). Increasing hyoid distance, intermolar palatal height, and piriform width were also weakly correlated with PhOP (r = 0.22, 0.16, and 0.17, respectively, p-value < 0.05). Inter-rater agreement between the two independent reviewers was good to excellent (ICC = 0.80 - 0.99).

Conclusions: This study demonstrated that increased hyoid distance, intermolar palatal height, and piriform width were associated with increased upper airway collapsibility as measured via PhOP. Retrognathia and transverse maxillary deficiency demonstrated a positive correlation with increased PhOP, which is contrary to the hypothesis. Further research is needed to evaluate how the complex interplay of anatomic and physiologic features impact patient selection and outcomes if sleep surgery is needed.