Main Article Content
Abstract
This study aimed to develop an artificial intelligence-based prediction model for evaluating the relationship between obstructive sleep apnea (OSA) severity and maxillofacial developmental disorders in children. A prospective cohort design was employed, monitoring 50 children (mean age 8.4±2.3 years, 58% male) with varying degrees of maxillofacial abnormalities over a 12-month period. Participants were stratified into four groups: maxillary constriction (n=15), mandibular retrognathia (n=15), mixed phenotype (n=10), and control (n=10). Comprehensive assessments included cephalometric measurements, intraoral scans, and polysomnography performed at baseline, 6-month, and 12-month intervals. A hybrid artificial intelligence architecture integrating gradient boosting algorithms and deep neural networks was developed using multimodal data. Results demonstrated significant correlations between specific maxillofacial parameters and OSA severity, with SNB angle (r=-0.68, p<0.001) and maxillary width (r=-0.61, p<0.001) showing the strongest associations. Multiple regression analysis identified SNB angle (β=-0.46, p<0.001), maxillary width (β=-0.39, p<0.001), and BMI (β=0.28, p=0.012) as significant independent predictors of AHI, collectively explaining 72% of OSA severity variance. The AI model achieved an overall accuracy of 89.6% in classifying OSA severity, with differential performance across phenotype groups (mandibular retrognathia: 93.1%, maxillary constriction: 88.5%, mixed phenotype: 85.2%). Longitudinal follow-up revealed significant correlations between improvements in maxillofacial parameters and reductions in AHI, with stronger associations in younger children (5-8 years) compared to older children (9-12 years). This research provides an effective tool for assessing the relationship between OSA severity and maxillofacial developmental abnormalities in children, offering valuable insights for early risk stratification and personalized treatment strategies in pediatric sleep medicine.
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References
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References
S. Alsaeed et al., "Orthodontic and facial characteristics of craniofacial syndromic children with obstructive sleep apnea," Diagnostics, vol. 13, no. 13, p. 2213, 2023. https://doi.org/10.3390/diagnostics13132213.
Z. M. Vrankova et al., "Candidate genes for obstructive sleep apnea in non-syndromic children with craniofacial dysmorphisms–a narrative review," Frontiers in Pediatrics, vol. 11, p. 1117493, 2023. https://doi.org/10.3389/fped.2023.1117493.
V. Molnár, L. Kunos, L. Tamás, and Z. Lakner, "Evaluation of the applicability of artificial intelligence for the prediction of obstructive sleep apnoea," Applied Sciences, vol. 13, no. 7, p. 4231, 2023. https://doi.org/10.3390/app13074231.
M. Camacho et al., "Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta‐analysis," The Laryngoscope, vol. 127, no. 7, pp. 1712-1719, 2017. https://doi.org/10.1002/lary.26352.
P. Shah et al., "Artificial intelligence and machine learning in clinical development: a translational perspective," NPJ digital medicine, vol. 2, no. 1, p. 69, 2019. https://doi.org/10.1038/s41746-019-0148-3.
M. Nagendran et al., "Artificial intelligence versus clinicians: systematic review of design, reporting standards, and claims of deep learning studies," bmj, vol. 368, 2020. https://doi.org/10.1136/bmj.m689.
G. Bazoukis et al., "Application of artificial intelligence in the diagnosis of sleep apnea," Journal of Clinical Sleep Medicine, vol. 19, no. 7, pp. 1337-1363, 2023. https://doi.org/10.5664/jcsm.10532.
H. Han and J. Oh, "Application of various machine learning techniques to predict obstructive sleep apnea syndrome severity," Scientific Reports, vol. 13, no. 1, p. 6379, 2023. https://doi.org/10.1038/s41598-023-33170-7.
B. Pei, M. Xia, and H. Jiang, "Artificial intelligence in screening for obstructive sleep apnoea syndrome (OSAS): a narrative review," Journal of Medical Artificial Intelligence, vol. 6, 2023. https://doi.org/10.21037/jmai-22-79
R. Dai et al., "Enhanced machine learning approaches for OSA patient screening: model development and validation study," Scientific Reports, vol. 14, no. 1, p. 19756, 2024. https://doi.org/10.1038/s41598-024-70647-5.
A. Bandyopadhyay and C. Goldstein, "Clinical applications of artificial intelligence in sleep medicine: a sleep clinician’s perspective," Sleep and Breathing, vol. 27, no. 1, pp. 39-55, 2023. https://doi.org/10.1007/s11325-022-02592-4.
I. N. Ismail, P. K. Subramaniam, K. B. Chi Adam, and A. B. Ghazali, "Application of Artificial Intelligence in Cone-Beam Computed Tomography for Airway Analysis: A Narrative Review," Diagnostics, vol. 14, no. 17, p. 1917, 2024. https://doi.org/10.3390/diagnostics14171917.
J. Cassibba et al., "Analysis of mandibular jaw movements to assess ventilatory support management of children with obstructive sleep apnea syndrome treated with positive airway pressure therapies," Pediatric pulmonology, vol. 59, no. 7, pp. 1905-1911, 2024. https://doi.org/10.1002/ppul.27005.
H. L. Brennan and S. D. Kirby, "The role of artificial intelligence in the treatment of obstructive sleep apnea," Journal of Otolaryngology-Head & Neck Surgery, vol. 52, no. 1, pp. s40463-023-00621-0, 2023. https://doi.org/10.1186/s40463-023-00621-0.
R. F. Bittar, S. E. Duailibi, G. P. R. Prado, L. M. Ferreira, and M. D. Pereira, "Cephalometric measures correlate with polysomnography parameters in individuals with midface deficiency," Scientific Reports, vol. 11, no. 1, p. 7949, 2021. https://doi.org/10.1038/s41598-021-85935-7.
G.-W. Ji, C.-Y. Jiao, Z.-G. Xu, X.-C. Li, K. Wang, and X.-H. Wang, "Development and validation of a gradient boosting machine to predict prognosis after liver resection for intrahepatic cholangiocarcinoma," BMC cancer, vol. 22, no. 1, p. 258, 2022. https://doi.org/10.1186/s12885-022-09352-3.
H. Finke, A. Drews, C. Engel, and B. Koos, "Craniofacial risk factors for obstructive sleep apnea—systematic review and meta‐analysis," Journal of Sleep Research, vol. 33, no. 1, p. e14004, 2024. https://doi.org/10.1111/jsr.14004.
C. Hansen, A. Markström, and L. Sonnesen, "Specific dento‐craniofacial characteristics in non‐syndromic children can predispose to sleep‐disordered breathing," Acta Paediatrica, vol. 111, no. 3, pp. 473-477, 2022. https://doi.org/10.1111/apa.16202.
L. M. Sun, H.-W. Chiu, C. Y. Chuang, and L. Liu, "A prediction model based on an artificial intelligence system for moderate to severe obstructive sleep apnea," Sleep and Breathing, vol. 15, pp. 317-323, 2011. https://doi.org/10.1007/s11325-010-0384-x.
H. Wang, W. Xu, A. Zhao, D. Sun, Y. Li, and D. Han, "Clinical characteristics combined with craniofacial photographic analysis in children with obstructive sleep apnea," Nature and Science of Sleep, pp. 115-125, 2023. https://doi.org/10.2147/NSS.S400745.
D. Bertoni, L. M. Sterni, K. D. Pereira, G. Das, and A. Isaiah, "Predicting polysomnographic severity thresholds in children using machine learning," Pediatric research, vol. 88, no. 3, pp. 404-411, 2020. https://doi.org/10.1038/s41390-020-0944-0.
J. B. Martinot et al., "Clinical validation of a mandibular movement signal based system for the diagnosis of pediatric sleep apnea," Pediatric pulmonology, vol. 57, no. 8, pp. 1904-1913, 2022. https://doi.org/10.1002/ppul.25320.
N. C. F. Fagundes, S. Gianoni-Capenakas, G. Heo, and C. Flores-Mir, "Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis," Journal of Clinical Sleep Medicine, vol. 18, no. 7, pp. 1865-1875, 2022. https://doi.org/10.5664/jcsm.9904.
G. C. Gutiérrez‐Tobal, D. Álvarez, L. Kheirandish‐Gozal, F. Del Campo, D. Gozal, and R. Hornero, "Reliability of machine learning to diagnose pediatric obstructive sleep apnea: Systematic review and meta‐analysis," Pediatric pulmonology, vol. 57, no. 8, pp. 1931-1943, 2022. https://doi.org/10.1002/ppul.25423.
A. Abd-Alrazaq et al., "Detection of sleep apnea using wearable AI: systematic review and meta-analysis," Journal of Medical Internet Research, vol. 26, p. e58187, 2024. https://doi.org/10.2196/58187.