Indian Journal of Sleep Medicine

Register      Login

VOLUME 14 , ISSUE 1 ( January-March, 2019 ) > List of Articles


Role of Malocclusion and Craniofacial Morphology in Obstructive Sleep Apnea

Poonam Sharma, Pranav Kapoor, Raj K Maurya

Keywords : Dentofacial deformities, Malocclusion, Orthodontics

Citation Information : Sharma P, Kapoor P, Maurya RK. Role of Malocclusion and Craniofacial Morphology in Obstructive Sleep Apnea. Indian Sleep Med 2019; 14 (1):10-17.

DOI: 10.5005/jp-journals-10069-0033

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Being one of the most pervasive disorder with far-reaching adverse health implications, understanding the etiology of obstructive sleep apnea (OSA) in relation to craniofacial morphology and malocclusion is critical with regards to rational treatment planning, management, and long-term stability. The principal aim of this article is to present an invaluable insight into the role of malocclusion in the genesis of OSA by reviewing the orthodontic and sleep medicine literature pertaining to pediatric and adult OSA populations. The potential mechanisms underlying the association of malocclusion and OSA are also discussed.

PDF Share
  1. Deatherage JR, Roden RD, Zouhary K. Normal Sleep Architecture. Semin Orthod 2009;15:86-87.
  2. McNicholas WT. Clinical diagnosis and assessment of obstructive sleep apnoea syndrome. Monaldi Arch Chest Dis 1997; 52:37-42.
  3. Park JG, Ramar K, Olson EJ. Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea. Mayo Clin Proc. 2011;86(6):549-555.
  4. Al Lawati NM, Patel SR, Ayas NT. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis 2009;51:285-293.
  5. American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester (IL): American Academy of Sleep Medicine, 2005.
  6. Bixler EO, Vgontzas AN, Lin H-M, Liao D, Calhoun S, Vela-Bueno A et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep 2009;32(6):731-736.
  7. Sutherland K, Lee RW, Cistulli PA. Obesity and craniofacial structure as risk factors for obstructive sleep apnoea: Impact of ethnicity. Respirology 2012;17:213-222.
  8. Jureyda S, Shucard DW. Obstructive Sleep Apnea—An Overview of the Disorder and Its Consequences. Semin Orthod 2004;10:63-72.
  9. Hudgel DW. The role of upper airway anatomy and physiology in obstructive sleep apnea. Clin Chest Med. 1992;13:383–398.
  10. Banabilh SM, Suzina AH, Dinsuhaimi S, Samsudin AR, Singh GD. Craniofacial obesity in patients with obstructive sleep apnea. Sleep Breath. 2009;13:19-24.
  11. Guilleminault C, Khramtsov A. Upper airway resistance syndrome in children: a clinical review. Semin Pediatr Neurol 2001;8:207-215.
  12. Lyberg T, Krogstad O, Djupesland G. Cephalometric analysis in patients with obstructive sleep apnoea syndrome: I. Skeletal Morphology. The Journal of Laryngology & Otology. 1989 Mar;103(3):287-292.
  13. Seto BH, Gotsopoulos H, Sims MR, Cistulli PA. Maxillary morphology in obstructive sleep apnoea syndrome. Eur J Orthod. 2001;23: 703-714.
  14. Adachi S, Lowe AA, Tsuchiya M, Ryan CF, Fleetham JA. Genioglossus muscle activity and inspiratory timing in obstructive sleep apnea. Am J Orthod Dentofac Orthop 1993;104:138-145.
  15. Miyao E, Noda A, Miyao M, Yasuma F, Inafuku S. The Role of Malocclusion in Non-obese Patients with Obstructive Sleep Apnea Syndrome. Intern Med 2008;47:1573-1578.
  16. Ikävalko T, Tuomilehto H, Pahkala R, Tompuri T, Laitinen T, Myllykangas R et al. Craniofacial morphology but not excess body fat is associated with risk of having sleep disordered breathing—the PANIC Study (a questionnaire-based inquiry in 6–8-year-olds). Eur J Pediatr. 2012; 171(12):1747–1752.
  17. Zucconi M, Caprioglio A, Calori G, Ferini-Strambi L, Oldani A, Castronovo C et al. Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case control study. Eur Respir J. 1999;13(2):411-417.
  18. Pirilä-Parkkinen K, Pirttiniemi P, Nieminen P, Tolonen U, Pelttari U, Löppönen H. Dental arch morphology in children with sleep disordered breathing. Eur J Orthod. 2009;31(2):160-167.
  19. Huynh NT, Morton PD, Rompré PH, Papadakis A, Remise C. Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations. Am J Orthod Dentofac Orthop. 2011;140(6):762-770.
  20. Schütz TCB, Dominguez GC, Hallinan MP, Cunha TCA, Tufik S. Class II correction improves nocturnal breathing in adolescents. The Angle Orthodontist 2011;81(2):222-228.
  21. Zhang C, He H, Ngan P. Effects of twin block appliance on obstructive sleep apnea in children: a preliminary study. Sleep Breath. 2013;17(4):1309-1314.
  22. Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep 2004; 27(4): 761-766.
  23. Villa MP, Rizzoli A, Miano S, Malagola C. Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath. 2011;15(2):179-184.
  24. Pliska BT, Lee J, Chadha NK. Prevalence of malocclusion in children with sleep-disordered breathing. Journal of Dental Sleep Medicine. 2017;4(2):41-44.
  25. Tsuchiya M, Lowe AA, Pae E, Freetham J. Obstructive sleep apnea subtypes by cluster analysis. Am J Orthod Dentofac Orthop 1992;533- 542:101.
  26. Hou HM, Hagg U, Sam K, Rabie AB, Wong RW. Lam B et al. Dentofacial Characteristics of Chinese Obstructive Sleep Apnea Patients in Relation to Obesity and Severity. The Angle Orthodontist 2006;76: 962-969.
  27. Ang PK, Andrew Sandham, Wan Cheng Tan. Craniofacial Morphology and Head Posture in Chinese Subjects With Obstructive Sleep Apnea. Semin Orthod 2004;10:90-96.
  28. Liu Y, Lowe AA, Zeng X, Fu M, Fleetham JA. Cephalometric comparisons between Chinese and Caucasian patients with obstructive sleep apnea. Am. J. Orthod. Dentofacial Orthop. 2000;117:479-485.
  29. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope 2000;110:1689-1693.
  30. Lee RW, Vasudavan S, Hui DS, Prvan T, Petocz P, Darendeliler MA et al. Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep 2010; 33: 1075-1080.
  31. Vigg A, Vigg A, Vigg A. Obstructive sleep apnea in a referral population in India. Sleep 2010;33:1075-1080.
  32. Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr. Craniofacial structure and obstructive sleep apnea syndrome–a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop 1996;109:163-172.
  33. Johal A, Conaghan C. Maxillary morphology in obstructive sleep apnea: A cephalometric and model study. Angle Orthod 2004;74: 648-656.
  34. Cistulli PA, Richards GN, Palmisano RG, Unger G, Sullivan CE. Influence of maxillary constriction on nasal resistance and sleep severity in patients with Marfan's syndrome. Chest. 1996;110:1184-1193.
  35. Johal A, Patel SI, Battagel JM: The relationship between craniofacial anatomy and obstructive sleep apnoea: A case controlled study. J Sleep Res 2007;16:319-326.
  36. Okubo M, Suzuki M, Horiuchi A, Okabe S, Ikeda K, Higano S et al. Morphologic analyses of mandible and upper airway soft tissue by MRI of patients with obstructive sleep apnea hypopnea syndrome. Sleep 2006;29:909-915.
  37. Conley RS, Legan HL. Correction of severe obstructive sleep apnea with bimaxillary transverse distraction osteogenesis and maxillomandibular advancement. Am J Orthod Dentofac Orthop. 2006;129:283-292.
  38. Banabilh SM, Samsudin AR, Suzina AH, Dinsuhaimi S. Facial Profile Shape, Malocclusion and Palatal Morphology in Malay Obstructive Sleep Apnea Patients. Angle Orthod. 2010;80:37-42.
  39. Zonato AI, Bittencourt LR, Martinho FL, Junior JF, Gregorio LC, Tufik S. Association of systematic head and neck physical examination with severity of obstructive sleep apnea hypopnea syndrome. Laryngoscope. 2003;113:973-980.
  40. Capistrano A, Cordeiro A, Capelozza Filho L, Almeida VC, Castro e Silva PI, Martinez S et al. Facial morphology and obstructive sleep apnea. Dental Press J Orthod. 2015 Nov-Dec;20(6):60-67.
  41. Nainan O, Jayan B, Mitra R, Ghosh S, Chopra SS, Mukherjee M. Dental Arch Morphology as a Predictor of Sleep Disordered Breathing. Sleep Hypn 2017;19(2):30-37
  42. Patel N, Nagle M. Having An Angle Class II Malocclusion Is Associated With A Higher Incidence Of Obstructive Sleep Apnea: An Evidence- Based Synopsis. UTHSCSA CATs Library CAT #2364. 2013
  43. Banabilh SM. Orthodontic view in the diagnoses of obstructive sleep apnea. J Orthod Sci. 2017 Jul-Sep;6(3):81-85.
  44. Roedig JJ, Phillips BA, Morford LA, Van Sickels JE, Falcao-Alencar G, Fardo DW, et al. Comparison of BMI, AHI, and apolipoprotein E å4 (APOE-å4) alleles among sleep apnea patients with different skeletal classifications. J Clin Sleep Med. 2014;10(4):397-402.
  45. Posnick JC, Adachie A, Singh N, Choi E. “Silent” Sleep Apnea in Dentofacial Deformities and Prevalence of Daytime Sleepiness After Orthognathic and Intranasal Surgery. J Oral Maxillofac Surg 2018;76:833-843.
  46. Kawashima S, Peltomäki T, Sakata H, Mori K, Happonen RP, Rönning O. Craniofacial morphology in preschool children with sleep-related breathing disorder and hypertrophy of tonsils. Acta Paediatrica 2002;91:71-77.
  47. Shintani T, Asakura K, Kataura A. Evaluation of the role of adenotonsillar hypertrophy and facial morphology in children with obstructive sleep apnea. J Otorhinolaryngol Relat Spec. 1997;59: 286-291.
  48. Guilleminault C, Stoohs R. Chronic snoring and obstructive sleep apnea syndrome in children. Lung 1990;168:912-919.
  49. Harris EF, Johnson MG. Heritability of craniometric and occlusal variables: a longitudinal sib analysis. Am J Orthod Dentofacial Orthop 1991;99:258-268.
  50. Pirila K, Tahvanainen P, Huggare J, Nieminen P, Lopponen H. Sleeping positions and dental arch dimensions in children with suspected obstructive sleep apnea syndrome. Eur J Oral Sci.1995;103:285-291.
  51. Zettergren-Wijk L, Forsberg CM, Linder–Aronson S. Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea — a 5 year follow-up study. Eur J Orthod 2006;28:319-326.
  52. Cartwright RD. Effect of sleep position on sleep apnea severity. Sleep 1984;7:110-114.
  53. Maeda K, Tsuiki S, Fukuda T, Takise Y, Inoue Y. Is maxillary dental arch constriction common in Japanese male adult patients with obstructive sleep apnoea? Eur J Orthod 2014;36:403-408.
  54. Flores-Mir C, Korayem M, Heo G, Witmans M, Major MP, Major PW. Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: A systematic review and metaanalysis. J Am Dent Assoc. 2013;144(3):269-277.
  55. Maurya RK, Singh H, Mishra HA, Gupta A. Modified Interim Mandibular Advancement (MIMA) Appliance for Symptomatic Correction of Obstructive Sleep Apnea. J Clin Diagn Res 2016 Aug;10(8):ZH01-ZH03.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.