# Comparison of craniofacial skeletal morphology in pediatric obstructive sleep apnea-hypopnea syndrome patients with class II and class III malocclusions: a retrospective cross-sectional study

## TL;DR

The study compares skull and facial structures in children with sleep apnea and different types of jaw misalignment, finding distinct patterns that could guide treatment.

## Contribution

The study identifies unique craniofacial patterns in pediatric OSAHS patients with Class II and III malocclusions, offering insights for personalized treatment planning.

## Key findings

- Class III patients show mandibular growth restriction and compensatory protrusion.
- Class II patients exhibit high-angle, long-face morphology with clockwise growth rotation.
- Significant differences were found in multiple cephalometric parameters between the two groups.

## Abstract

This study aimed to investigate craniofacial skeletal morphology in pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with different malocclusion types.

A retrospective cross-sectional analysis study was conducted at Chengdu Second People's Hospital from 2023 to 2024. A total of 299 children diagnosed with OSAHS (aged 10–12 years) were included. Craniofacial structures were assessed using Jarabak and Ricketts methods. Patients were divided by malocclusion type: Class II (n = 150, 56.7% male, mean age 11.2 ± 0.6) and Class III (n = 149, 50.3% male, mean age 11.4 ± 0.8). Group differences in cephalometric parameters were compared using independent samples t-tests and Mann–Whitney U tests, as appropriate.

Significant differences were found between groups. Compared to Class II, Class III patients had lower ANB angle (−2.8 ± 2.6° vs. 5.6 ± 1.9°, Cohen's d = 1.23), Wits appraisal (–2.9 ± 3.7 mm vs. 2.6 ± 0.7 mm, Cohen's d = 2.02), SN:GoMe (103.1 ± 6.0% vs. 106.7 ± 9.0%, Cohen's d = 0.48), MP/FH (32.9 ± 2.99° vs. 37.3 ± 2.65°, Cohen's d = 1.57), Xi-Pm/DC-Xi (29.3 ± 2.1° vs. 24.6 ± 3.1°, Cohen's d = 1.81), and ANS-Xi-Pm (47.8 ± 2.9° vs. 50.7 ± 2.4°, Cohen's d = 1.11) (all P < 0.05). Class III patients showed higher S-Ar:Ar-Go (75.9 ± 7.2% vs. 80.9 ± 13.0%, Cohen's d = 0.48), NP/FH (88.1 ± 2.9° vs. 83.1 ± 1.86°, Cohen's d = 2.14), Pt-Gn/Ba-N (92.2 ± 2.1° vs. 79.6 ± 2.4°, Cohen's d = 5.44), and Hy-C3 distance (5.8 ± 0.9 mm vs. 3.4 ± 0.4 mm, Cohen's d = 3.26) (all P < 0.05). No significant differences were observed in other parameters (N-S-Ar, S-Ar-Go; P > 0.05).

Distinct craniofacial skeletal patterns exist in pediatric OSAHS patients with different malocclusions. Class III patients demonstrate mandibular growth restriction with compensatory protrusion, while Class II patients display high-angle, long-face morphology with clockwise growth rotation. These findings have important clinical implications for individualized orthodontic and surgical planning in the management of pediatric OSAHS, highlighting the need for early assessment of craniofacial structure in affected children.