Oral and craniofacial determinants of high-risk obstructive sleep apnea in adults: an analytical cross-sectional study

Sleep-disordered breathing, particularly obstructive sleep apnea (OSA), is a multifactorial condition influenced by systemic, anthropometric, and craniofacial factors. Dental professionals may play an important role in early identification due to routine assessment of oral and oropharyngeal structures. This study evaluated systemic, oral, and cephalometric factors associated with high risk of OSA among adults attending a tertiary care dental institution in Kerala, India. In this analytical cross-sectional study, 350 adults were screened using the Malayalam version of the Berlin Questionnaire and Epworth Sleepiness Scale. Anthropometric parameters, blood pressure, and detailed oral examinations were recorded. Participants were categorized as high- or low-risk for OSA. Seventy individuals from each group underwent lateral cephalometric evaluation for craniofacial and airway analysis. Associations were assessed using chi-square tests and independent t-tests. Multivariable logistic regression was performed to identify factors independently associated with high risk of OSA. Seventy-six participants (21.7%) were classified as high risk of OSA. Individuals at high risk demonstrated significantly greater age, body mass index (BMI), neck circumference, waist circumference, blood pressure, Mallampati score, temporomandibular disorders (TMD), and dental attrition ( p < 0.05). In the multivariable analysis, higher BMI (OR = 1.28; p < 0.001), TMD (OR = 2.37; p = 0.016), and dental attrition (OR = 3.37; p = 0.005) remained independently associated with high risk of OSA. Cephalometric evaluation revealed mandibular retrusion, increased ANB angle, reduced posterior facial height, inferior hyoid positioning, and significantly narrower pharyngeal airway dimensions among high-risk individuals ( p < 0.05). High risk of OSA in this South Indian cohort was associated with both obesity-related and craniofacial characteristics. Oral findings including temporomandibular disorders, dental attrition and higher Mallampati score may serve as valuable chairside indicators for identifying individuals at increased risk of OSA. Integrating systemic and dental assessments into routine clinical practice may facilitate early recognition and timely referral within a multidisciplinary model of OSA care. Not applicable.