title: Craniofacial morphology and sleep apnea in children with obstructed upper airways: differences between genders.
abstract: OBJECTIVE
  To correlate sleep apnea with craniofacial characteristics and facial patterns according to gender.
  
  
  METHODS
  In this prospective survey we studied 77 male and female children (3-12 years old) with an upper airway obstruction due to tonsil and adenoid enlargement. Children with lung problems, neurological disorders and syndromes, obstructive septal deviation, previous orthodontic treatment, orthodontic surgeries or oral surgeries, or obesity were excluded. Patients were subjected to physical examinations, nasal fiberoptic endoscopy, teleradiography for cephalometric analysis, and polysomnography. Cephalometric analysis included the following skeletal craniofacial measurements: facial axis (FA), facial depth (FD), mandibular plane angle (MP), lower facial height (LFH), mandibular arch (MA), and vertical growth coefficient (VERT) index.
  
  
  RESULTS
  The prevalence of sleep apnea was 46.75% with no statistical difference between genders. Among children with obstructive sleep apnea (Apneia Hypopnea Index - AHI ≥ 1) boys had higher AHI values than girls. A predominance of the dolichofacial pattern (81.9%) was observed. The following skeletal craniofacial measurements correlated with AHI in boys: FD (r(s)=-0.336/p=0.020), MP (r(s)=0.486/p=0.00), and VERT index (r(s)=-0.337/p=0.019). No correlations between craniofacial measurements and AHI were identified in girls.
  
  
  CONCLUSIONS
  Craniofacial morphology may influence the severity of sleep apnea in boys but not in girls.
authors.affiliation: Otolaryngology Department, University of São Paulo, School of Medicine, Brazil. renatadifran@uol.com.br
authors.forename: Renata
authors.initials: R
authors.lastname: Di Francesco
authors.forename: Roberta
authors.initials: R
authors.lastname: Monteiro
authors.forename: Maria Luiza de Melo
authors.initials: ML
authors.lastname: Paulo
authors.forename: Fernando
authors.initials: F
authors.lastname: Buranello
authors.forename: Rui
authors.initials: R
authors.lastname: Imamura
mesh_terms: D000234:Adenoids / Q000473:pathology; D002508:Cephalometry / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000453:epidemiology* / Q000473:pathology*; D004724:Endoscopy; D005145:Face / Q000002:abnormalities; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology; D009296:Nasal Cavity / Q000473:pathology; D014066:Palatine Tonsil / Q000473:pathology; D017286:Polysomnography; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012727:Sex Characteristics; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000473:pathology*