Integrative Assessment of Cephalometric and Polysomnographic Features in Paediatric Obstructive Sleep Apnea: A Cross-Sectional Study

Ailiang Liu,1 Qinghua Lu,1 Xiao Huang,1 Hairui Li,1 Zhijiang Hou,1 Weinan Lin,1 Ting Huang,1 Yunfei Cui,1 Tao Wu,1 Yaxin Xiao,1 Sandip Patil,2,3,* Qin Yang1,* 1Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 2Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 3Paediatric Research Institute, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Sandip Patil, Email [email protected] Qin Yang, Email [email protected]: This study aimed to characterize pediatric patients with suspected sleep-disordered breathing (SDB) and evaluate whether cephalometric features and clinical indicators can predict obstructive sleep apnea (OSA) severity, as confirmed by polysomnography (PSG).Methods: A cross-sectional study was conducted among 228 children referred for sleep-related breathing concerns. Data collected included demographics, clinical symptoms (snoring, mouth-breathing, open-mouth posture, malocclusion), and cephalometric measurements (ANB, SNA, SNB angles, and nasopharyngeal soft tissue ratio). Overnight PSG assessed apnea–hypopnea index (AHI), rapid eye movement (REM) sleep proportion, and oxygen saturation. Children were classified as OSA-positive (AHI > 1 event/h) or non-OSA. Statistical analyses included t-tests, ANOVA, Pearson correlations, logistic regression, receiver operating characteristic (ROC) analysis, principal component analysis (PCA), and decision-tree modelling to identify predictors and stratify risk.Results: Among 228 children (mean age 7.4 ± 2.9 years; 62.7% male), 109 underwent PSG. The OSA group showed significantly higher ANB angles (5.8° ± 1.9 vs 3.9° ± 1.4, p < 0.01), increased nasopharyngeal soft tissue ratios (0.72 ± 0.09 vs 0.59 ± 0.07, p < 0.001), and elevated BMI compared with non-OSA children. AHI correlated positively with ANB (r = 0.48) and soft tissue ratio (r = 0.62), and negatively with minimum SaO2 (r = – 0.47). Habitual snoring (OR = 4.3), mouth-breathing (OR = 2.6), and incomplete lip closure (OR = 3.1) independently predicted OSA. A combined clinical–cephalometric model achieved an AUC of 0.86. PCA revealed distinct anatomical–functional clusters, and a decision-tree model using ANB > 5°, tissue ratio ≥ 0.68, and snoring classified OSA with 82% sensitivity and 78% specificity.Conclusion: Pediatric OSA is strongly linked to craniofacial imbalance, adenoidal hypertrophy, and functional symptoms. Cephalometric parameters, particularly ANB angle and nasopharyngeal soft tissue ratio, combined with simple clinical indicators, offer reliable, low-cost screening for early OSA detection where PSG access is limited.Keywords: paediatric obstructive sleep apnea, cephalometric analysis, polysomnography, airway anatomy, clinical predictors