{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T08:33:02Z","timestamp":1790670782821,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Objective: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder featuring a repeated closure of the upper airway during sleep. Craniofacial anatomy is a potential risk and worsening factor for OSA. This study aims to assess the relationship between cephalometric features of craniofacial morphology and OSA severity in a population of patients with OSA. Material and Methods: A sample of forty-two patients (n = 42, M = 76%, mean age = 57.8 \u00b1 10.8) with a polysomnographically (PSG) confirmed diagnosis of OSA were recruited and underwent cephalometric evaluation of 16 cephalometric variables. In addition, the apnea\u2013hypopnea index (AHI), oxygen desaturation (SatMin), Epworth sleepiness scale (ESS), and body mass index (BMI) were assessed. Then t-tests were performed to compare the values of all cephalometric variables between two AHI severity-based groups (mild-to-moderate = AHI \u2264 30; severe = AHI &gt; 30). Single- and multiple-variable regression analyses were performed to assess the associations between AHI scores and cephalometric features. Results: Mean AHI, SatMin, and BMI were 31.4 ev\/h, 78.7%, and 28.1, respectively. The cephalometric variables were not significantly different between the two OSA-severity groups (p &gt; 0.05). Multiple-variable regression analyses showed that gonial angle and nasopharynx space were negatively associated with AHI, explaining 24.6% of the total variance. Conclusion: This investigation reported that severity of AHI scores in patients with OSA showed a negative correlation with gonial angle and nasopharynx space. As a general remark, although maxillofacial anatomy can be a predisposing factor for OSA, disease severity depends mainly upon other variables.<\/jats:p>","DOI":"10.3390\/jcm11154572","type":"journal-article","created":{"date-parts":[[2022,8,7]],"date-time":"2022-08-07T22:51:46Z","timestamp":1659912706000},"page":"4572","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Correlation between Apnea Severity and Sagittal Cephalometric Features in a Population of Patients with Polysomnographically Diagnosed Obstructive Sleep Apnea"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7835-574X","authenticated-orcid":false,"given":"Matteo","family":"Pollis","sequence":"first","affiliation":[{"name":"Department of Medical Biotechnology, School of Dentistry, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-7640","authenticated-orcid":false,"given":"Frank","family":"Lobbezoo","sequence":"additional","affiliation":[{"name":"Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghizlane","family":"Aarab","sequence":"additional","affiliation":[{"name":"Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology, School of Dentistry, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6269-961X","authenticated-orcid":false,"given":"Rosario","family":"Marchese-Ragona","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Otolaryngology Section, University of Padova, Via Belzoni, 160, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4352-3085","authenticated-orcid":false,"given":"Daniele","family":"Manfredini","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology, School of Dentistry, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"key":"ref_1","unstructured":"Berry, R.B., Brooks, R., Gamaldo, C.E., Harding, S.M., Lloyd, R.M., Quan, S.F., Troester, M.T., and Vaughn, B.V. (2016). For the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, American Academy of Sleep Medicine. Version 2.3."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1056\/NEJM199304293281704","article-title":"The occurrence of sleep-disordered breathing among middle-aged adults","volume":"328","author":"Young","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"Peppard","year":"2013","journal-title":"Am. J. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1513\/pats.200709-155MG","article-title":"The epidemiology of Adult Obstructive Sleep Apnea","volume":"5","author":"Punjabi","year":"2008","journal-title":"Prom. Am. Thorac. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis","volume":"7","author":"Benjafield","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.smrv.2016.12.003","article-title":"Phenotypic approaches to obstructive sleep apnoea\u2014New pathways for the targeted therapy","volume":"37","author":"Eckert","year":"2018","journal-title":"Sleep Med. Rev."},{"key":"ref_7","first-page":"1110","article-title":"Obstructive sleep apnea: Evaluation and Treatment IN Posnick JC","volume":"Volume 116","author":"Posnick","year":"2013","journal-title":"Principles and Practice of Orthognathic Surgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1164\/ajrccm.163.4.2005136","article-title":"The relationship between craniofacial morphology and obstructive sleep apnea in whites and in African-Americans","volume":"163","author":"Cakirer","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1136\/thx.2004.031591","article-title":"Craniofacial profile in Asians and white subjects with obstructive sleep apnoea","volume":"60","author":"Lam","year":"2005","journal-title":"Thorax"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1172\/JCI115751","article-title":"Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism)","volume":"89","author":"Mezzanotte","year":"1998","journal-title":"J. Clin. Investig."},{"key":"ref_11","first-page":"E298","article-title":"Clinical manifestations of sleep apnea","volume":"7","author":"Stansbury","year":"2015","journal-title":"J. Thorac Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1164\/ajrccm.157.1.9706079","article-title":"Effects of age on sleep apnea in men: I. Prevalence and severity","volume":"157","author":"Bixler","year":"1998","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.chest.2017.06.011","article-title":"Personalized Management Approach for OSA","volume":"153","author":"Carberry","year":"2018","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"101229","DOI":"10.1016\/j.smrv.2019.101229","article-title":"Phenotypes of responders to mandibular advancement device therapy in obstructive sleep apnea patients: A systematic review and meta-analysis","volume":"49","author":"Chen","year":"2020","journal-title":"Sleep Med. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.ejim.2012.05.013","article-title":"Obstructive sleep apnea syndrome","volume":"23","author":"Mannarino","year":"2012","journal-title":"Eur. J. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"527","DOI":"10.5664\/jcsm.2148","article-title":"Detection of sleep disordered breathing and its central\/obstructive character using nasal cannula and finger pulse oximeter","volume":"8","author":"Sommermeyer","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"ref_17","first-page":"1560","article-title":"Sleep-Related Adductor Laryngeal Dystonia Causing Sleep Apnea: A Sleep-Related Breathing Disorder Diagnosed With Sleep Endoscopy and Treated With Botulinum Toxin","volume":"23","author":"Vianello","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_18","first-page":"437","article-title":"Recent advances in the diagnosis and management of obstructive sleep apnea. Padova Sleep Apnea Study Group","volume":"107","author":"Vianello","year":"2016","journal-title":"Minerva Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"20150085","DOI":"10.1259\/dmfr.20150085","article-title":"Lateral teleradiography of the head as a diagnostic tool used to predict obstructive sleep apnea","volume":"45","author":"Armalaite","year":"2016","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.smrv.2016.01.007","article-title":"Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and a meta-analysis of cephalometric studies","volume":"31","author":"Neelapu","year":"2017","journal-title":"Sleep Med. Rev."},{"key":"ref_21","first-page":"244","article-title":"Comparison of Cephalometric Variables in Non-obese and Obese Patients with Obstructive Sleep Apnea","volume":"28","author":"Ozturk","year":"2011","journal-title":"Balkan Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.jcms.2012.12.010","article-title":"Craniofacial skeletal architecture and obstructive sleep apnoea syndrome severity","volume":"41","author":"Costa","year":"2013","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.joms.2011.12.012","article-title":"Relations between Obstructive Sleep Apnea Syndrome and Specific Cephalometric Measurements, Body Mass Index and Apnea-hypopnea Index","volume":"70","author":"Cillo","year":"2012","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1007\/s11325-013-0830-7","article-title":"Lateral cephalometric analysis and the risks of moderate to severe obstructive sleep-disordered breathing in Thai patients","volume":"17","author":"Banhiran","year":"2013","journal-title":"Sleep Breath"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.5664\/jcsm.5198","article-title":"Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies","volume":"11","author":"Manfredini","year":"2015","journal-title":"J. Clin. Sleep Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/ejo\/22.4.353","article-title":"A cephalometric comparison of subjects with snoring and obstructive sleep apnoea","volume":"22","author":"Battagel","year":"2000","journal-title":"Eur. J. Orthod."},{"key":"ref_27","first-page":"2624","article-title":"Evaluation of the upper airway cross-sectional area changes in different degrees of severity of obstructive sleep apnea syndrome: Cephalometric and dynamic CT study","volume":"26","author":"Yucel","year":"2005","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1055\/s-0039-1698862","article-title":"Cephalometric comparison of pharyngeal airway in snoring and non-snoring patients","volume":"5","author":"Kurt","year":"2011","journal-title":"Eur. J. Dent."},{"key":"ref_29","first-page":"271","article-title":"Craniofacial morphology in Craotian patients with obstructive sleep apnea","volume":"37","author":"Dogas","year":"2013","journal-title":"Coll. Antropol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1365-2869.2007.00599.x","article-title":"The relationship between craniofacial anatomy and obstructive sleep apnoea: A case-controlled study","volume":"16","author":"Johal","year":"2007","journal-title":"J. Sleep Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/jsr.12485","article-title":"Facial phenotype in obstructive sleep apnea-hypopnea syndrome: A systematic review and meta-analysis","volume":"26","author":"Bahn","year":"2017","journal-title":"J. Sleep Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1046\/j.1365-2842.2003.01130.x","article-title":"Craniofacial morphology and obstructive sleep apnoea: A cephalometric analysis","volume":"30","author":"Hoekema","year":"2003","journal-title":"J. Oral Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1046\/j.1440-1819.2000.00774.x","article-title":"Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms","volume":"54","author":"Miyao","year":"2000","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/S1079-2104(95)80012-3","article-title":"Cephalometric comparison of characteristics in chronically snoring patients with and without sleep apnea syndrome","volume":"80","author":"Frohberg","year":"1995","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1179\/2151090314Y.0000000003","article-title":"Oral Appliances for the Treatment of Obstruc tive Sleep Apnea in Patients with Low C-PAP Compliance: A Long-Term Case Series","volume":"32","author":"Manfredini","year":"2014","journal-title":"Cranio"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"key":"ref_37","first-page":"93","article-title":"Clustering-based Characterization of Clinical Phenotypes in Obstructive Sleep Apnoea Using Severity, Obesity, and Craniofacial Pattern","volume":"42","author":"Hyun","year":"2020","journal-title":"Eur. J. Orthod."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1590\/2177-6709.20.6.060-067.oar","article-title":"Facial morphology and obstructive sleep apnea","volume":"20","author":"Capistrano","year":"2015","journal-title":"Dental Press J. Orthod."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.ajodo.2008.01.020","article-title":"Pharyngeal airway volume and shape from cone-beam computed tomography: Relationship to facial morphology","volume":"136","author":"Grauer","year":"2009","journal-title":"Am. J. Orthod. Dentofacial. Orthop."},{"key":"ref_40","first-page":"762","article-title":"The relationship of vertical skeletofacial morphology to oropharyngeal airway shape using cone-beam computed tomography: Possible applications for airway restriction","volume":"140","author":"Haskell","year":"2011","journal-title":"Angle Orthod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.bjorl.2020.05.026","article-title":"Craniofacial morphology in patients with obstructive sleep apnea: Cephalometric evaluation","volume":"88","author":"Tepedino","year":"2022","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1001\/jama.2020.3514","article-title":"Diagnosis and Management of Obstructive Sleep Apnea: A Review","volume":"323","author":"Gottlieb","year":"2020","journal-title":"JAMA"},{"key":"ref_43","first-page":"143","article-title":"Cephalometric and demographic characteristics of obstructive sleep apnea: An evaluation with partial least squares analysis","volume":"67","author":"Lowe","year":"1997","journal-title":"Angle Orthod."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1054\/bjom.2000.0551","article-title":"Craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: Cephalometric study I 85 patients","volume":"39","author":"Paoli","year":"2001","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"9828","DOI":"10.1038\/s41598-022-13850-6","article-title":"Comparison of polysomnographic and cephalometric parameters based on positional and rapid eye movement sleep dependency in obstructive sleep apnea","volume":"12","author":"Jo","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1093\/sleep\/33.8.1075","article-title":"Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea","volume":"33","author":"Lee","year":"2010","journal-title":"Sleep"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/15\/4572\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:04:29Z","timestamp":1760141069000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/15\/4572"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,5]]},"references-count":46,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jcm11154572"],"URL":"https:\/\/doi.org\/10.3390\/jcm11154572","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,5]]}}}