Prevalence of Obstructive Sleep Apnea in orthodontic adult patients with different skeletal classes using STOP-BANG Questionnaire Questionnaire study

Abstract

Obstructive sleep apnea is the most common type of sleep apnea. In most cases of obstructive sleep apnea, air stops flowing to the lungs because of a blockage in the upper airway. Symptoms of OSA may include daytime fatigue, xerostomia, headache in the morning, depression, restlessness during sleep, snoring, waking up suddenly and feeling like chocking. There are many predisposing factors for OSA such as obesity, upper airway obstruction, large tonsils, large tongue and small jaw bone. There are many people with sleep apnea who have not been diagnosed or received treatment. The Apnea–Hypopnea Index (AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep. OSA can be diagnosed by polysomnogram, xrays (CBCT, MRI and lateral cephalometric) and questionnaires like STOP-BANG and Berlin. Depending on the cause and level of apnea, there are different methods of treatment like CPAP which is the gold standard treatment for OSA, surgery and mandibular repositioning device (MRD). The aim of the study is to determine the prevalence of OSA in orthodontic patients with different skeletal classes using STOP-BANG Questionnaire. The sample consisted of 309 patients divided into 3 groups according to the ANB angle which was obtained from lateral cephalometric xrays. The x-rays were collected from the saved data and files from Orthodontic Department in Future University in Egypt. Group I skeletal Class I (152 subjects), Group II skeletal Class II (96 subjects) and Group III skeletal Class III (61 subjects). The patients were asked to fill out general medical history, sign of consent form and fill in the STOP-BANG questionnaire. Patient’s neck size was measured using tape measuring tool and patient’s weight measured by weighing scale. Body mass index (BMI) was obtained. Patients were also divided according to the gender into male (152 subjects) and female (157 subjects) groups, according to the age into patients ≤ 50 years (258 subjects) and patients > 50 years (51 subjects). They were divided according to 61 the BMI into patients with BMI ≤ 35 kg/m2 (194 subjects) and patients with BMI > 35 kg/m2 (115 subjects) and then they were divided according to the neck size into patients with small neck size which was in male  17 inch/43cm and in female  16 inch/41cm (293 subjects) and into patients with large neck size which was in male male ≥ 17 inch/43cm and in female ≥ 16 inch/41cm (16 subjects). The scores were collected to determine the prevalence of OSA in different skeletal classes. The results showed that the prevalence of subjects with low risk of OSA was 49.2%, intermediate risk was 31.1% and high risk was 19.7% there was no significant difference between the three groups. According to the gender there was a significantly higher percent of male n=15 (10%) than female n=6 (4%) in the high risk group and no significant difference was found across the low or the intermediate risk groups. According to the age there was a significantly higher percent of patients ≤ 50 years than those > 50 years in the low risk group, while the percent of patients ≤ 50 years was significantly lower than those > 50 years in the intermediate risk group and no significant difference was noticed in the high risk group. According to BMI there was no statistically significant difference was found regarding BMI groups across the OSA risk groups. According to the neck size There was a significantly higher percent of patients with small neck size than those with large neck size in the low risk group, while there was a significantly lower percent of patients with small neck size than those with large neck size in the high risk group and no significant difference was noticed among the intermediate risk group patients.