CRANIOFACIAL STRUCTURE AND OBSTRUCTIVE SLEEP-APNEA SYNDROME - A QUALITATIVE-ANALYSIS AND METAANALYSIS OF THE LITERATURE

The etiologic relevance of craniofacial structure to obstructive sleep apnea syndrome (OSAS) is controversial yet the premise of a causal as sociation serves to justify many treatments. A qualitative and quantit ative analysis of the literature was performed to examine the foundati on for any relationship between craniofacial structure and OSAS. A MED LINE search and investigation of the published and unpublished literat ure on diagnostic imaging and OSAS was toxonomically arranged. Each sa mple study was evaluated by using the following criteria: (a) appropri ate control group, (b) ''blinding'' of evaluators, (c) reliability mea sured, (d) random assignment of treatment, and (e) ''success'' was def ined adequately in efficacy studies. Morphologic variables were combin ed among studies and compared with controls drawn from either the same patient pool as the OSAS group, or matched for gender, age, and body mass index. Analysis revealed 32 review articles, 16 case reports, and 95 sample studies. Only seven sample studies drew a control group fro m the same patient pool, whereas five used matched controls. Only one of these studies satisfied all the qualitative criteria. Of the treatm ent efficacy studies, 10 defined outcome adequately. However, none of these met all the qualitative criteria. The most consistent, strong ef fect sizes with the highest potential diagnostic accuracies were for m andibular plane to hyoid, mandibular plane angle, and mandibular body length. Only mandibular body length demonstrated a clinically signific ant association with and diagnostic accuracy for OSAS. However, since this variable's controls were selected from the literature, possible e xplanations for a positive association include methodologic difference s between studies, varying magnification factors, and morphologic diff erences.