Prediction of obstructive sleep apnea with craniofacial photographic analysis

Richard W W Lee, Peter Petocz, Tania Prvan, Andrew S L Chan, Ronald R. Grunstein, Peter A. Cistulli

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    88 Citations (Scopus)


    Study Objectives: To develop models based on craniofacial photographic analysis for the prediction of obstructive sleep apnea (OSA). Design: Prospective cohort study. Setting: Sleep investigation unit in a university teaching hospital. Patients: One hundred eighty subjects (95.6% Caucasian) referred for the initial investigation of OSA were recruited consecutively. Interventions: Clinical assessment and frontal-profile craniofacial photographic analyses were performed prior to polysomnography. Prediction models for determining the presence of OSA (apnea-hypopnea index [AHI] ≥ 10) were developed using logistic regression analysis and classification and regression trees (CART). Measurements and Results: Obstructive sleep apnea was present in 63.3% of subjects. Using logistic regression, a model with 4 photographic measurements (face width, eye width, cervicomental angle, and mandibular length 1) correctly classified 76.1% of subjects with and without OSA (sensitivity 86.0%, specificity 59.1%, area under the receiver operating characteristics curve [AUC] 0.82). Combination of photographic and other clinical data improved the prediction (AUC 0.87), whereas prediction based on clinical assessment alone was lower (AUC 0.78). The optimal CART model provided a similar overall classification accuracy of 76.7%. Based on this model, 59.4% of the subjects were classified as either high or low risk with positive predictive value of 90.9% and negative predictive value of 94.7%, respectively. The remaining 40.6% of subjects have intermediate risk of OSA. Conclusions: Craniofacial photographic analysis provides detailed anatomical data useful in the prediction of OSA. This method allows OSA risk stratification by craniofacial morphological phenotypes.

    Original languageEnglish
    Pages (from-to)46-52
    Number of pages7
    Issue number1
    Publication statusPublished - 1 Jan 2009


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