Richard J Schwab1, Sarah E Leinwand2, Cary B Bearn2, Greg Maislin3, Ramya Bhat Rao2, Adithya Nagaraja4, Stephen Wang2, Brendan T Keenan2. 1. Division of Sleep Medicine, Philadelphia, PA; Center for Sleep & Circadian Neurobiology, Philadelphia, PA. Electronic address: rschwab@mail.med.upenn.edu. 2. Center for Sleep & Circadian Neurobiology, Philadelphia, PA. 3. Division of Sleep Medicine, Philadelphia, PA; Center for Sleep & Circadian Neurobiology, Philadelphia, PA. 4. University of Pennsylvania, Philadelphia, PA.
Abstract
BACKGROUND: OSA is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy by using digital morphometrics based on a laser ruler and to assess differences between subjects with OSA and control subjects and associations with the apnea-hypopnea index (AHI). To the best of our knowledge, this study is the first to use digital morphometrics to quantify intraoral risk factors for OSA. METHODS: Digital photographs were obtained by using an intraoral laser ruler and digital camera in 318 control subjects (mean AHI, 4.2 events/hour) and 542 subjects with OSA (mean AHI, 39.2 events/hour). RESULTS: The digital morphometric paradigm was validated and reproducible over time and camera distances. A larger modified Mallampati score and having a nonvisible airway were associated with a higher AHI, both unadjusted (P < .001) and controlling for age, sex, race, and BMI (P = .015 and P = .018, respectively). Measures of tongue size were larger in subjects with OSA vs control subjects in unadjusted models and controlling for age, sex, and race but nonsignificant controlling for BMI; similar results were observed with AHI severity. Multivariate regression suggests photography-based variables capture independent associations with OSA. CONCLUSIONS: Measures of tongue size, airway visibility, and Mallampati scores were associated with increased OSA risk and severity. This study shows that digital morphometrics is an accurate, high-throughput, and noninvasive technique to identify anatomic OSA risk factors. Morphometrics may also provide a more reproducible and standardized measurement of the Mallampati score. Digital morphometrics represent an efficient and cost-effective method of examining intraoral crowding and tongue size when examining large populations, genetics, or screening for OSA.
BACKGROUND: OSA is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy by using digital morphometrics based on a laser ruler and to assess differences between subjects with OSA and control subjects and associations with the apnea-hypopnea index (AHI). To the best of our knowledge, this study is the first to use digital morphometrics to quantify intraoral risk factors for OSA. METHODS: Digital photographs were obtained by using an intraoral laser ruler and digital camera in 318 control subjects (mean AHI, 4.2 events/hour) and 542 subjects with OSA (mean AHI, 39.2 events/hour). RESULTS: The digital morphometric paradigm was validated and reproducible over time and camera distances. A larger modified Mallampati score and having a nonvisible airway were associated with a higher AHI, both unadjusted (P < .001) and controlling for age, sex, race, and BMI (P = .015 and P = .018, respectively). Measures of tongue size were larger in subjects with OSA vs control subjects in unadjusted models and controlling for age, sex, and race but nonsignificant controlling for BMI; similar results were observed with AHI severity. Multivariate regression suggests photography-based variables capture independent associations with OSA. CONCLUSIONS: Measures of tongue size, airway visibility, and Mallampati scores were associated with increased OSA risk and severity. This study shows that digital morphometrics is an accurate, high-throughput, and noninvasive technique to identify anatomic OSA risk factors. Morphometrics may also provide a more reproducible and standardized measurement of the Mallampati score. Digital morphometrics represent an efficient and cost-effective method of examining intraoral crowding and tongue size when examining large populations, genetics, or screening for OSA.
Authors: L Chi; F-L Comyn; N Mitra; M P Reilly; F Wan; G Maislin; L Chmiewski; M D Thorne-FitzGerald; U N Victor; A I Pack; R J Schwab Journal: Eur Respir J Date: 2011-01-13 Impact factor: 16.671
Authors: Richard J Schwab; Michael Pasirstein; Laura Kaplan; Robert Pierson; Adonna Mackley; Robert Hachadoorian; Raanan Arens; Greg Maislin; Allan I Pack Journal: Am J Respir Crit Care Med Date: 2005-10-06 Impact factor: 21.405
Authors: Richard W W Lee; Sivabalan Vasudavan; David S Hui; Tania Prvan; Peter Petocz; M Ali Darendeliler; Peter A Cistulli Journal: Sleep Date: 2010-08 Impact factor: 5.849
Authors: Richard J Schwab; Michael Pasirstein; Robert Pierson; Adonna Mackley; Robert Hachadoorian; Raanan Arens; Greg Maislin; Allan I Pack Journal: Am J Respir Crit Care Med Date: 2003-05-13 Impact factor: 21.405
Authors: Kate Sutherland; Brendan T Keenan; Lia Bittencourt; Ning-Hung Chen; Thorarinn Gislason; Sarah Leinwand; Ulysses J Magalang; Greg Maislin; Diego R Mazzotti; Nigel McArdle; Jesse Mindel; Allan I Pack; Thomas Penzel; Bhajan Singh; Sergio Tufik; Richard J Schwab; Peter A Cistulli Journal: J Clin Sleep Med Date: 2019-04-15 Impact factor: 4.062
Authors: Kate Sutherland; Richard W W Lee; Tat On Chan; Susanna Ng; David S Hui; Peter A Cistulli Journal: J Clin Sleep Med Date: 2018-07-15 Impact factor: 4.062
Authors: Fabiola G Rizzatti; Diego R Mazzotti; Jesse Mindel; Greg Maislin; Brendan T Keenan; Lia Bittencourt; Ning-Hung Chen; Peter A Cistulli; Nigel McArdle; Frances M Pack; Bhajan Singh; Kate Sutherland; Bryndis Benediktsdottir; Ingo Fietze; Thorarinn Gislason; Diane C Lim; Thomas Penzel; Bernd Sanner; Fang Han; Qing Yun Li; Richard Schwab; Sergio Tufik; Allan I Pack; Ulysses J Magalang Journal: Chest Date: 2020-04-15 Impact factor: 10.262