HEAD AND NECK The comparison of cephalometric characteristics in nonobese obstructive sleep apnea subjects and primary snorers cephalometric measures in nonobese OSA and primary snorers Meltem Esen Akpinar • M. Mazhar C ¸ elikoyar • Aytug Altundag • Ismail Kocak Received: 25 June 2010 / Accepted: 19 November 2010 / Published online: 4 December 2010 Ó Springer-Verlag 2010 Abstract The objective of the study is to evaluate the cephalometric characteristics and investigate the measure- ment differences between habitual snorers and subjects with obstructive sleep apnea (OSA) in nonobese Turkish male population. The study design is prospective and nonran- domized. The setting is sleep-snoring center of referral hospital. Total of 60 male subjects constituted OSA (n = 20), habitual snorer (n = 20) and control group (n = 20). Clinical evaluation, Epworth sleepiness scale scoring, flexible nasopharyngoscopy, polysomnography, Tweed and Delaire analysis on cephalometric images were performed. The main outcome meaasures include cranial base maxillary angle (SNA), cranial base mandibular angle (SNB), posterior airway space (PAS), mandibular plane and hyoid distance (MPH), soft palate length, soft palate thick- ness, cranial height ratio (C2/C1), cranial base angle (C1\C3), and craniofacial angle (C3\F1) parameters were compared. In comparison of OSA and habitual snorers, PAS at palatal and tongue base level (p = 0.037, p = 0.001), MPH (p = 0.07), C3\F1 (p = 0.001) were found statisti- cally different. In comparison of controls with OSA and habitual snorers PAS at palatal level (p \ 0.001, p = 0.01), MPH (p \ 0.001, p = 0.015), soft plate length (p \ 0.001, p \ 0.001) and thickness (p \ 0.001, p = 0.056) were found statistically different. The soft palate length, PAS, C3\F1 and MPH were detected as the most effective four parameters in discriminating three groups. In conclusion, this study increased MPH, soft palate length and decreased PAS were identified as the determinant characteristics in OSA and habitual snoring group. PAS and MPH values reported were higher in OSA as compared to habitual snor- ers. The selected cephalometric data may be used as a complementary to endoscopic examination, sleep tests and imaging techniques to determine anatomic site, management plan and follow-up of outcome in habitual snorers and OSA subjects. Keywords Cephalometry Á Craniofacial analysis Á Sleep apnea Á Snoring Á Upper airway Á Body mass index Introduction Obstructive sleep apnea (OSA) is characterized by intermit- tent partial or complete upper airway obstruction and sleep fragmentation affecting 2–4% of middle-aged men [1]. Clinical course is progressive from snoring to apnea episodes with increasing durations. Its progressive nature and potential systemic complications require special attention in diagnosis and treatment [2]. Habitual snoring is defined as the regular every night sound arising from the vibration of soft palate and adjacent tissues during sleep [3]. Craniofacial abnormalities as well as pharyngeal collapse during sleep are considered to be the underlying etiologic and pathophysiological factors in progression of OSA [4]. Overnight polysomnography (PSG) is accepted as gold standard in the diagnosis, but does not identify the obstruction site. The assessment of obstruction site is of importance for the guidance of patient management. M. E. Akpinar (&) Á M. M. C ¸ elikoyar Department of Otolaryngology, Head and Neck Surgery Istanbul Surgery Hospital, Adnan Saygun Cad Go ¨zde Sok Engin B Apt Da:13 2.Ulus Bes ¸iktas ¸, Istanbul, Turkey e-mail: meltemakpinar@hotmail.com A. Altundag Clinic of Otolaryngology, Head and Neck Surgery, Diyarbakır Training and Research Hospital, Diyarbakir, Turkey I. Kocak Department of Otolaryngology, Head and Neck Surgery, Yeditepe University School of Medicine, Istanbul, Turkey 123 Eur Arch Otorhinolaryngol (2011) 268:1053–1059 DOI 10.1007/s00405-010-1448-z