Association of Craniofacial Skeletal and Soft Tissue Characteristics With Severe Obstructive Sleep Apnea in Age-specific and BMI-specific Patient Groups

PURPOSE: To identify the key craniofacial anatomic characteristics associated with the prevalence of severe obstructive sleep apnea (OSA) in patient cohorts stratified by age and body mass index (BMI). METHODS: This prospective study was conducted at the Beijing Anzhen Hospital Center for Sleep Medicine and Science between December 2023 and March 2024. Patients suspected of having OSA underwent overnight polysomnography, along with computed tomography scans of the head and neck, to evaluate the skeletal and soft tissue characteristics. Multivariable analysis was conducted to explore the independent risk factors associated with the prevalence of severe OSA (apnea hypopnea index ≥30 events/h) after adjusting for age, sex, BMI, and neck circumference. RESULTS: Among the 118 participants, 75 (63.6%) were diagnosed with severe OSA. Skeletal variables, such as vertical airway length, and soft tissue-related variables, like soft palate length, were independently correlated with the prevalence of severe OSA. Furthermore, subgroup analysis revealed that all skeletal variables and a few soft tissue parameters were associated with severe OSA in patients aged older than 40 years, whereas only a specific soft tissue variable was independently associated with the occurrence of severe OSA in those aged younger than or equal to 40 years. In addition, certain soft tissue-related variables were notably associated with severe OSA in obese patients (BMI >28 kg/m 2 ), whereas only specific skeletal variables were acted independent risk factors for severe OSA in non-obese patients (BMI ≤28 kg/m 2 ). CONCLUSION: Craniofacial skeletal and soft tissue features play essential roles in the prevalence of severe OSA, with variations observed based on age and BMI.