Retropalatal Cross-Sectional Area Is Predictive of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis

Cleft Palate Craniofac J. 2020 May;57(5):560-565. doi: 10.1177/1055665619882571. Epub 2019 Oct 24.


Objective: There is a high rate of obstructive sleep apnea (OSA) in patients with syndromic craniosynostosis (SCS). Little is known about the airway anatomy in this population. The purpose of this study is to characterize the 3 dimensional (3D) upper airway in patients with SCS with and without OSA.

Design: This is a retrospective study of patients with SCS treated at Boston Children's Hospital from 2000 to 2015. Patients were divided into OSA and no-OSA groups based on polysomnography. Predictor variables included age, sex, body mass index (BMI), and 3D upper airway measurements. The primary outcome variable was the presence or absence of OSA. Secondary outcome variables were apnea-hypopnea index and oxygen saturation nadir. Descriptive and bivariate statistics were computed, and significance was set as P < .05.

Results: There were 24 patients: 16 in the OSA group and 8 in the no-OSA group. The 2 groups did not differ significantly by age, BMI, or syndromic diagnosis. The presence of OSA was associated with a smaller minimum retropalatal cross-sectional area (minRPCSA; P < .001). In a logistic regression model controlling for age, sex, and upper airway length, minRPCSA was the primary predictor of OSA (P ≤ .002). Receiver operating characteristic analysis determined minRPCSA = 55.3 mm2 to be the optimal diagnostic threshold for OSA, with sensitivity = 100% and specificity = 87.5% (P < .001).

Conclusion: A minRPCSA ≤55.3 mm2 is predictive of the presence of OSA in patients with SCS.

Keywords: Le Fort III osteotomy; craniosynostosis; midface advancement; obstructive sleep apnea; sleep apnea; upper airway.

MeSH terms

  • Boston
  • Child
  • Craniosynostoses*
  • Humans
  • Patients
  • Retrospective Studies
  • Sleep Apnea, Obstructive*