CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review
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REVIEW
CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review Noura A. Alsufyani & Mohammed A. Q. Al-Saleh & Paul W. Major
Received: 17 September 2012 / Revised: 28 November 2012 / Accepted: 24 December 2012 / Published online: 24 January 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose The aim of this study was to review studies using cone beam computed tomography (CBCT) to assess dimensional changes in the upper airway after appliance or surgical therapy in subjects with obstructive sleep apnoea and to correlate CBCT findings with treatment outcome. Method Several electronic databases were searched. Studies that met selection criteria were evaluated using a customized evaluation tool. Results Study parameters were met in seven articles. Fifty adults were assessed using CBCT 1.6–10 months after appliance therapy or maxillary mandibular advancement surgery with or without genial tubercle advancement. Airway parameters measured were linear, cross-sectional (CS) area, volume or airway function. In only two validated surgical case reports, airway volume increased by 6.5–9.7 cm3 (>80 %) and minimum CS area by 0.1–1.2 cm2 (21 and 269 %). Conclusion The available published studies show evidence of CBCT measured anatomic airway changes with surgery and dental appliance treatment for OSA. There is insufficient literature pertaining to the use of CBCT to assess treatment outcomes to reach a conclusion. High-quality evidence level studies, with statistically appropriate sample sizes and cross validated clinically, are needed to determine if CBCT airway dimensional changes are suitable for assessment of treatment outcome.
N. A. Alsufyani : M. A. Q. Al-Saleh : P. W. Major Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada N. A. Alsufyani (*) Department of Dentistry, Edmonton Clinic Health Academy, 5th floor, 11405-87 AVE NW, Edmonton T6G 1C9, AB, Canada e-mail: [email protected]
Keywords Sleep apnoea syndromes . Sleep apnoea obstructive . Cone-beam computed tomography (CBCT) . Treatment outcome
Introduction Sleep-disordered breathing (SDB) is a spectrum of conditions with abnormal respiratory pattern and/or decreases in oxyhaemoglobin saturation during sleep [1, 2]. Obstructive sleep apnoea syndrome (OSA) is the severe end of that spectrum [1, 3]. Recently, OSA is being seen in greater numbers even within the paediatric and adolescent age range [4]. OSA may affect 2–4 % of middle-aged adult population in North America and 2–3 % children [1, 3, 5–7]. In the 2009 Wisconsin Sleep Cohort Study, the reported SDB prevalence was 9 % in women and 24 % in men, based on apnoea– hypopnea index (AHI) >5 [8]. Management of OSA may include one or more of conservative approach (e.g. diet or altering sleep position), continuous positive airway pressure (CPAP), oral appliance therapy (e.g. mandibular advancement devices) and surgery [4, 9]. Currently, oral appliances are underused partly due to their cost and diffi
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