Subscribe to RSS

DOI: 10.1055/s-0045-1802650
Systematic Review of Craniofacial Phenotyping in Pediatric Obstructive Sleep Apnea: An Approach to Standardization of Methods
Funding Source This review was supported by Sultan Ahmad Shah Medical Centre @IIUM under the SRGS Project (SRG21–057–0057).

Abstract
Craniofacial phenotyping methods are pivotal in understanding and diagnosing pediatric obstructive sleep apnea (OSA). However, the lack of standardized methods often leads to inconsistencies, hindering the reliability and validity of quantitative analyses in this field. This systematic review aims to evaluate existing craniofacial phenotyping methodologies and their key parameters to propose standardization measures to enhance the reliability and validity of future quantitative analyses on this topic. A comprehensive search of electronic databases was conducted following PRISMA guidelines, resulting in the inclusion of 13 studies. Data extraction focused on the types of phenotyping methods and the parameters or measurements used. Our findings revealed a variation in the phenotyping techniques and a wide array of parameters used across studies, highlighting the need for standardization. The authors proposed a framework of parameters for future evaluation of craniofacial morphologies of pediatric OSA. By standardizing the assessment of these craniofacial morphologies, future research efforts can ensure consistency, facilitating more reliable and valid quantitative analyses in this critical area of study.
Publication History
Received: 14 March 2024
Accepted: 20 September 2024
Article published online:
07 March 2025
© 2025. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil
Izzati Nabilah Ismail, Nor Diyana Ismail. Systematic Review of Craniofacial Phenotyping in Pediatric Obstructive Sleep Apnea: An Approach to Standardization of Methods. Sleep Sci 2025; 18: s00451802650.
DOI: 10.1055/s-0045-1802650
-
References
- 1
Chan J,
Edman JC,
Koltai PJ.
Obstructive sleep apnea in children. Am Fam Physician 2004; 69 (05) 1147-1154
MissingFormLabel
- 2
Blechner M,
Williamson AA.
Consequences of Obstructive Sleep Apnea in Children. Curr Probl Pediatr Adolesc Health
Care 2016; 46 (01) 19-26
MissingFormLabel
- 3
Weider DJ,
Baker GL,
Salvatoriello FW.
Dental malocclusion and upper airway obstruction, an otolaryngologist's perspective.
Int J Pediatr Otorhinolaryngol 2003; 67 (04) 323-331
MissingFormLabel
- 4
Gulotta G,
Iannella G,
Vicini C.
et al.
Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. Int
J Environ Res Public Health 2019; 16 (18) 3235
MissingFormLabel
- 5
Fagundes NCF,
Gianoni-Capenakas S,
Heo G,
Flores-Mir C.
Craniofacial features in children with obstructive sleep apnea: a systematic review
and meta-analysis. J Clin Sleep Med 2022; 18 (07) 1865-1875
MissingFormLabel
- 6
Chianchitlert A,
Luengthamchat N,
Saengphen T,
Sirisoontorn I.
Craniofacial and Upper Airway Morphology in Pediatric Obstructive Sleep Apnea Patients:
A Systematic Review. J Int Dent Med Res. 2022; 15 (01) 412-421
MissingFormLabel
- 7
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 meta-analysis. J Am Dent Assoc 2013; 144 (03) 269-277
MissingFormLabel
- 8
Zinchuk AV,
Gentry MJ,
Concato J,
Yaggi HK.
Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches.
Sleep Med Rev 2017; 35: 113-123
MissingFormLabel
- 9
Au CT,
Chan KCC,
Zhang J.
et al.
Intermediate phenotypes of childhood obstructive sleep apnea. J Sleep Res 2021; 30
(03) e13191
MissingFormLabel
- 10
Luzzi V,
Ierardo G,
Di Carlo G,
Saccucci M,
Polimeni A.
Obstructive sleep apnea syndrome in the pediatric age: the role of the dentist. Eur
Rev Med Pharmacol Sci 2019; 23 (1, Suppl) 9-14
MissingFormLabel
- 11
Stark TR,
Pozo-Alonso M,
Daniels R,
Camacho M.
Pediatric Considerations for Dental Sleep Medicine. Sleep Med Clin 2018; 13 (04) 531-548
MissingFormLabel
- 12
Leibovitz S,
Haviv Y,
Sharav Y,
Almoznino G,
Aframian D,
Zilberman U.
Pediatric sleep-disordered breathing: Role of the dentist. Quintessence Int 2017;
48 (08) 639-645
MissingFormLabel
- 13
Altalibi M,
Saltaji H,
Roduta Roberts M,
Major MP,
MacLean J,
Major PW.
Developing an index for the orthodontic treatment need in paediatric patients with
obstructive sleep apnoea: a protocol for a novel communication tool between physicians
and orthodontists. BMJ Open 2014; 4 (09) e005680
MissingFormLabel
- 14
Wilhelm CP,
deShazo RD,
Tamanna S,
Ullah MI,
Skipworth LB.
The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol 2015;
115 (02) 96-102
MissingFormLabel
- 15
Anderson SM,
Lim HJ,
Kim KB,
Kim SW,
Kim SJ.
Clustering of craniofacial patterns in Korean children with snoring. Korean J Orthod
2017; 47 (04) 248-255
MissingFormLabel
- 16
Pacheco MCT,
Fiorott BS,
Finck NS,
Araújo MT.
Craniofacial changes and symptoms of sleep-disordered breathing in healthy children.
Dental Press J Orthod 2015; 20 (03) 80-87
MissingFormLabel
- 17
Hsu WC,
Kang KT,
Yao CJ.
et al.
Evaluation of Upper Airway in Children with Obstructive Sleep Apnea Using Cone-Beam
Computed Tomography. Laryngoscope 2021; 131 (03) 680-685
MissingFormLabel
- 18
Inoshita A,
Kasai T,
Matsuoka R.
et al.
Age-stratified sex differences in polysomnographic findings and pharyngeal morphology
among children with obstructive sleep apnea. J Thorac Dis 2018; 10 (12) 6702-6710
MissingFormLabel
- 19
Yap B,
Kontos A,
Pamula Y.
et al.
Differences in dentofacial morphology in children with sleep disordered breathing
are detected with routine orthodontic records. Sleep Med 2019; 55: 109-114
MissingFormLabel
- 20
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 (02) 160-167
MissingFormLabel
- 21
Soares MM,
Romano FL,
Dias FVDS.
et al.
Association between the intensity of obstructive sleep apnea and skeletal alterations
in the face and hyoid bone. Braz J Otorhinolaryngol 2022; 88 (03) 331-336
MissingFormLabel
- 22
Carvalho FR,
Lentini-Oliveira DA,
Carvalho GMM,
Prado LBF,
Prado GF,
Carvalho LBC.
Sleep-disordered breathing and orthodontic variables in children–pilot study. Int
J Pediatr Otorhinolaryngol 2014; 78 (11) 1965-1969
MissingFormLabel
- 23
Ikävalko T,
Närhi M,
Eloranta AM.
et al.
Predictors of sleep disordered breathing in children: the PANIC study. Eur J Orthod
2018; 40 (03) 268-272
MissingFormLabel
- 24
Perri RA,
Kairaitis K,
Cistulli P,
Wheatley JR,
Amis TC.
Surface cephalometric and anthropometric variables in OSA patients: statistical models
for the OSA phenotype. Sleep Breath 2014; 18 (01) 39-52
MissingFormLabel
- 25
Ceccanti G,
Caruso S,
Pasini M,
Giuca MR,
Lardani L,
Severino M.
Facial skeletal alterations in mouth breathing paediatric patients: cephalometric
evaluations. J Biol Regul Homeost Agents 2020; 34 (1, Suppl. 1) 23-32 DENTAL SUPPLEMENT.
MissingFormLabel
- 26
Ardehali MM,
Zarch VV,
Joibari ME,
Kouhi A.
Cephalometric Assessment of Upper Airway Effects on Craniofacial Morphology. J Craniofac
Surg 2016; 27 (02) 361-364
MissingFormLabel
- 27
Bittar RF,
Duailibi SE,
Prado GPR,
Ferreira LM,
Pereira MD.
Cephalometric measures correlate with polysomnography parameters in individuals with
midface deficiency. Sci Rep 2021; 11 (01) 7949
MissingFormLabel
- 28
Lee RWW,
Chan ASL,
Grunstein RR,
Cistulli PA.
Craniofacial phenotyping in obstructive sleep apnea–a novel quantitative photographic
approach. Sleep 2009; 32 (01) 37-45
MissingFormLabel
- 29
Yuen HM,
Chan KC,
Chu WCW.
et al.
Craniofacial phenotyping by photogrammetry in Chinese prepubertal children with obstructive
sleep apnea. Sleep 2023; 46 (03) zsac289
MissingFormLabel
- 30
Hsueh WY,
Kang KT,
Yao CJ.
et al.
Measurements of craniofacial morphology using photogrammetry in children with sleep-disordered
breathing. Int J Pediatr Otorhinolaryngol 2022; 162: 111287
MissingFormLabel
- 31
Katyal V,
Pamula Y,
Martin AJ,
Daynes CN,
Kennedy JD,
Sampson WJ.
Craniofacial and upper airway morphology in pediatric sleep-disordered breathing:
Systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2013; 143 (01)
20-30.e3
MissingFormLabel
- 32
Dusdal J,
Powell JJW.
Benefits, Motivations, and Challenges of International Collaborative Research: A Sociology
of Science Case Study. Sci Public Policy 2021; 48 (02) 235-245
MissingFormLabel
- 33
Liu SYC,
Wayne Riley R,
Pogrel A,
Guilleminault C.
Sleep Surgery in the Era of Precision Medicine. Atlas Oral Maxillofac Surg Clin North
Am 2019; 27 (01) 1-5
MissingFormLabel
- 34
Page MJ,
McKenzie JE,
Bossuyt PM.
et al.
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
Syst Rev 2021; 10 (01) 89
MissingFormLabel
- 35
Manrikyan GE,
Vardanyan IF,
Markaryan MM.
et al.
Association between the Obstructive Sleep Apnea and Cephalometric Parameters in Teenagers.
J Clin Med 2023; 12 (21) 6851
MissingFormLabel
- 36
Bozzini MF,
Di Francesco RC,
Soster LA.
Clinical and anatomical characteristics associated with obstructive sleep apnea severity
in children. Clinics (Sao Paulo) 2022; 77: 100131
MissingFormLabel
- 37
Lumbau AMI,
Melodia D,
Meloni SM.
et al.
Obstructive Sleep Apnoea And Malocclusion In Early Paediatric Patients: A Cross-Sectional
Survey. Clin Trials Dent 2022; 4 (04) 5-11
MissingFormLabel
- 38
Xu Q,
Wang X,
Li N,
Wang Y,
Xu X,
Guo J.
Craniofacial and upper airway morphological characteristics associated with the presence
and severity of obstructive sleep apnea in Chinese children. Front Pediatr 2023; 11:
01-10 Available from https://www.frontiersin.org/articles/10.3389/fped.2023.1124610 cited 2024 Feb 20 [Internet]
MissingFormLabel
- 39
Wang H,
Xu W,
Zhao A,
Sun D,
Li Y,
Han D.
Clinical Characteristics Combined with Craniofacial Photographic Analysis in Children
with Obstructive Sleep Apnea. Nat Sci Sleep 2023; 15: 115-125
MissingFormLabel
- 40
Emsaeili F,
Sadrhaghighi A,
Sadeghi-Shabestari M,
Nastarin P,
Niknafs A.
Comparison of superior airway dimensions and cephalometric anatomic landmarks between
8-12-year-old children with obstructive sleep apnea and healthy children using CBCT
images. J Dent Res Dent Clin Dent Prospect 2022; 16 (01) 18-23
MissingFormLabel
- 41
Murakami A,
Kawanabe H,
Hosoya H,
Fukui K.
Effect of sleep-disturbed breathing on maxillofacial growth and development in school-aged
children. Orthod Waves 2021; 80 (02) 87-95
MissingFormLabel
- 42
Ahmad L,
Kapoor P,
Bhaskar S,
Khatter H.
Screening of obstructive sleep apnea (OSA) risk in adolescent population and study
of association with craniofacial and upper airway morphology. J Oral Biol Craniofac
Res 2020; 10 (04) 807-813
MissingFormLabel
- 43
Smith DF,
Dalesio NM,
Benke JR.
et al.
Anthropometric and Dental Measurements in Children with Obstructive Sleep Apnea. J
Clin Sleep Med 2016; 12 (09) 1279-1284
MissingFormLabel
- 44
Marino A,
Nota A,
Caruso S,
Gatto R,
Malagola C,
Tecco S.
Obstructive sleep apnea severity and dental arches dimensions in children with late
primary dentition: An observational study. Cranio 2021; 39 (03) 225-230
MissingFormLabel
- 45
Brockmann PE,
Schaefer C,
Poets A,
Poets CF,
Urschitz MS.
Diagnosis of obstructive sleep apnea in children: a systematic review. Sleep Med Rev
2013; 17 (05) 331-340
MissingFormLabel
- 46
Buchanan A,
Cohen R,
Looney S,
Kalathingal S,
De Rossi S.
Cone-beam CT analysis of patients with obstructive sleep apnea compared to normal
controls. Imaging Sci Dent 2016; 46 (01) 9-16
MissingFormLabel
- 47
Di Francesco R,
Monteiro R,
Paulo Mde M,
Buranello F,
Imamura R.
Craniofacial morphology and sleep apnea in children with obstructed upper airways:
differences between genders. Sleep Med 2012; 13 (06) 616-620
MissingFormLabel
- 48
Certal V,
Catumbela E,
Winck JC,
Azevedo I,
Teixeira-Pinto A,
Costa-Pereira A.
Clinical assessment of pediatric obstructive sleep apnea: a systematic review and
meta-analysis. Laryngoscope 2012; 122 (09) 2105-2114
MissingFormLabel
- 49
Neelapu BC,
Kharbanda OP,
Sardana HK.
et al.
Craniofacial and upper airway morphology in adult obstructive sleep apnea patients:
A systematic review and meta-analysis of cephalometric studies. Sleep Med Rev 2017;
31: 79-90
MissingFormLabel
- 50
Feltner C,
Wallace IF,
Aymes S.
et al.
Screening for Obstructive Sleep Apnea in Adults: Updated Evidence Report and Systematic
Review for the US Preventive Services Task Force. JAMA 2022; 328 (19) 1951-1971
MissingFormLabel
- 51
Finke H,
Drews A,
Engel C,
Koos B.
Craniofacial risk factors for obstructive sleep apnea-systematic review and meta-analysis.
J Sleep Res 2024; 33 (01) e14004
MissingFormLabel
- 52
Wang J,
Zhao Y,
Yang W.
et al.
Correlations between obstructive sleep apnea and adenotonsillar hypertrophy in children
of different weight status. Sci Rep 2019; 9 (01) 11455
MissingFormLabel
- 53
Jara SM,
Weaver EM.
Association of palatine tonsil size and obstructive sleep apnea in adults. Laryngoscope
2018; 128 (04) 1002-1006
MissingFormLabel
- 54
Zicari AM,
Rugiano A,
Ragusa G.
et al.
The evaluation of adenoid hypertrophy and obstruction grading based on rhinomanometry
after nasal decongestant test in children. Eur Rev Med Pharmacol Sci 2013; 17 (21)
2962-2967
MissingFormLabel