Differences in three-dimensional upper airway anatomy between asian and European patients with obstructive sleep apnea

Liyue Xu, Brendan T. Keenan, Andrew S. Wiemken, Luqi Chi, Bethany Staley, Zhifang Wang, Jianjun Wang, Bryndis Benedikstdottir, Sigurdur Juliusson, Allan I. Pack, Thorarinn Gislason, Richard J. Schwab

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28 Scopus citations


AbstractStudy Objectives: This study evaluated differences in upper airway, soft tissues and craniofacial structures between Asians from China and Europeans from Icelandwith OSA using three-dimensional magnetic resonance imaging (MRI).Methods: Airway sizes, soft tissue volumes, and craniofacial dimensions were compared between Icelandic (N = 108) and Chinese (N = 57) patients with oxygendesaturation index (ODI) = 10 events/h matched for age, gender, and ODI. Mixed effects models adjusting for height or BMI and residual differences in age and ODIwere utilized.Results: In our matched sample, compared to Icelandic OSA patients, Chinese patients had smaller BMI (p < 0.0001) and neck circumference (p = 0.011). In covariateadjusted analyses, Chinese showed smaller retropalatal airway size (p = 0.002), and smaller combined soft tissues, tongue, fat pads, and pterygoid (all p = 0.0001),but male Chinese demonstrated a larger soft palate volume (p = 0.001). For craniofacial dimensions, Chinese demonstrated bigger ANB angle (p = 0.0196), differentlyshaped mandibles, including shorter corpus length (p < 0.0001) but longer ramus length (p < 0.0001), and a wider (p < 0.0001) and shallower (p = 0.0001) maxilla.Conclusions: Compared to Icelandic patients of similar age, gender and ODI, Chinese patients had smaller retropalatal airway and combined soft tissue, but biggersoft palate volume (in males), and differently shaped mandible and maxilla with more bony restrictions. Results support an ethnic difference in upper airwayanatomy related to OSA, which may inform targeted therapies.

Original languageEnglish
Issue number5
StatePublished - May 1 2020


  • Ethnicity
  • Obstructive sleep apnea
  • Three-dimensional magnetic resonance imaging
  • Upper airway structure


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