Classification of facial phenotypes in Asian patients with obstructive sleep apnea

Abstract

Backgroud

The facial phenotypes of Asian obstructive sleep apnea (OSA) patients remain unclear.

Objectives

(1) To describe the facial features of OSA patients. (2) To develop a model based on facial contour indicators to predict OSA. (3) To classify the facial phenotypes of Asian OSA patients.

Materials and methods

110 patients with OSA (apnea-hypopnea index [AHI] ≥ 10/h) and 50 controls (AHI< 10/h) were selected to measure facial contour indicators. Indicators were compared between OSA patients and the control group. We used multivariable linear regression analysis to predict OSA severity and K-means cluster analysis to classify OSA patients into different phenotypes.

Results

We built a model to predict OSA which explained 49.1% of its variance and classified OSA patients into four categories. Cluster 1 (Skeletal type) had the narrowest facial width indicators with narrowing of the retroglossal airway. Cluster 2 (Obese type) had the widest face, and narrowest hard palate, retropalatal, and hypopharyngeal airways. Cluster 3 (Nose type) had the narrowest nasal cavity. Cluster 4 (Long type) had the longest airway length.

Conclusions and significance

Patients with OSA were classified into four categories, each of which identified different anatomic risk factors that can be used to select the treatment.

Chinese Abstract

背景：亚洲阻塞性睡眠呼吸暂停 (OSA) 患者的面部表型仍不清楚。

目的：（1）描述OSA患者的面部特征。 (2) 开发基于面部轮廓指标的模型来预测 OSA。 (3) 对亚洲 OSA 患者的面部表型进行分类。

材料和方法：挑选了110 名 OSA 患者（呼吸暂停低通气指数 [AHI] 10/h）和 50 名对照者（AHI<10/h）来测量面部轮廓指标。比较了OSA 患者和对照组之间的指标。我们使用多变量线性回归分析来预测 OSA严重性, 用 K 均值聚类分析将 OSA 患者分类为不同的表型。

结果：我们建立了一个预测 OSA 的模型。该模型解释了 49.1% 的方差并将 OSA患者分为四类。第一类（骨骼型）具有最窄的面部宽度指标, 舌后气道变窄。第 二类（肥胖型）脸最宽, 硬腭、腭后和下咽气道最窄。第 三类（鼻型）的鼻腔最窄。

第四类（长型）具有最长的气道长度。

结论与意义：将 OSA 患者分为四类, 每类确定了可用于选择治疗的不同解剖学危险因素。

Keywords:

• Obstructive sleep apnea
• facial
• facial phenotype
• morphology
• cluster analysis

Acknowledgment

Special thanks to Shengjie Gu, B.E., Mingjiu Wang, Ph.D., Fen Lin, M.D., Xueming Wang, B.E. and Wenli Zhang, B.E. for their help, guidance, and support in this paper.

Ethical approval

Retrospective studies do not involve ethical issues.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The processed data required to reproduce these findings cannot be shared at this time as the data also forms part of an ongoing study.

Additional information

Funding

This research was supported by the National Natural Science Foundation of China [81970866] and the Beijing Municipal Administration of Hospitals’ Youth Programme [PX2019005].