Craniofacial Development Characteristics in Children with Obstructive Sleep Apnea for Establishment and External Validation of the Prediction Model

Yonglong Su,1,&ast; Zitong Wang,1,&ast; Huanhuan Chang,2,&ast; Simin Zhu,1 Yanuo Zhou,1 Zine Cao,1 Lina Ma,1 Yuqi Yuan,1 Yushan Xie,1 Xiaoxin Niu,1 Chendi Lu,1 Yitong Zhang,1 Haiqin Liu,1 Na Shao,1 Libo Yin,3 Chao Si,2 Xiaoyong Ren,1 Yewen Shi1 1Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Otorhinolaryngology Head and Neck Surgery, Xi’an Children’s Hospital, Xi’an, People’s Republic of China; 3Department of Otorhinolaryngology Head and Neck Surgery, Xi’an Central Hospital, Xi’an, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaoyong Ren; Yewen Shi, Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xi Wu Road, Xi’an, Shaan’xi Province, 710004, People’s Republic of China, Email [email protected]; [email protected]: Aimed to analyze the developmental characteristics of craniofacial structures and soft tissues in children with obstructive sleep apnea (OSA) and to establish and evaluate prediction model.Methods: It’s a retrospective study comprising 747 children aged 2– 12 years (337 patients and 410 controls) visited the Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University (July 2017 to March 2024). Lateral head radiographs were obtained to compare the cephalometric measurements. The clinical prediction model was constructed using LASSO regression analysis. We analyzed 300 children from the Xi’an Children’s Hospital for external validation.Results: Children with OSA had a higher body mass, a higher tonsil grade, larger AN ratio (ratio of the adenoids to the skeletal upper airway width), larger radius of the tonsils, a smaller angle between the skull base and maxilla (SNA) and smaller angle between the skull base and mandible (SNB), a larger distance from the hyoid to the mandibular plane (H-MP) and smaller distance between the third cervical vertebra and hyoid (H-C), a larger thickness of the soft palate (SPT) and smaller inclination angle of the soft palate than those of the controls (all p < 0.05). A prediction model was constructed for 2– 12 years group (AUC of 0.812 [95% CI: 0.781– 0.842]). Age-specific prediction models were developed for preschool children (AUC of 0.769 [95% CI: 0.725– 0.814]), for school-aged children (AUC of 0.854 [95% CI: 0.812– 0.895]).Conclusion: Our study findings support the important role of craniofacial structures such as the hyoid, maxilla, mandible, and soft palate in pediatric OSA. Age-stratified predictive models for pediatric OSA indicated varying parameters across different age groups which underscore the necessity for stratifying by age in future research. The prediction model designed will greatly assist health care practitioners with rapidly identifying.Keywords: pediatric, OSA, cephalometric measurements, prediction model