In this case-control family study of sleep-disordered breathing (SDB), we describe the distributions of SDB and SDB risk factors in African-Americans and Caucasians. A total of 225 African-Americans and 622 Caucasians, ages 2 to 86 yr, recruited as members of families with an individual with known sleep apnea (85 index families) or as members of neighborhood control families (63 families) were studied with an overnight home sleep-study, questionnaires, and physical measurements. A subsample underwent cephalometry. Outcome measures were the respiratory disturbance index (RDI) and a binary variable indicating the presence of increased apneic activity (IAA). In both races, a strong relationship was demonstrated between the (log transformed) RDI and age and age2. African-Americans with SDB were younger than Caucasians with SDB (37.2 +/- 19.5 versus 45.6 +/- 18.7 yr, p < 0.01). In subjects < or = 25 yr, RDI level and IAA prevalence were higher in African-Americans (odds ratio, adjusted for obesity, sex, proband sampling, and familial clustering, 1.88, 1.03 to 3.52, 95% CI). In this age group, racial differences also were observed in the relationship between RDI and age (p < 0.001 for the RDI-age interaction). This suggests that young African-Americans may be at increased risk for sleep apnea.

The purpose of this study was to describe the pattern of bony and soft tissue growth of the oropharynx in a sample of healthy, orthodontically untreated children. The sample consisted of 16 males and 16 females with lateral cephalograms at 6, 9, 12, 15, and 18 years of age, for a total of 160 lateral cephalometric radiographs. All subjects were enrolled in the Broadbent Bolton Study and their radiographs were used to produce the Bolton Standard Templates. Each radiograph was traced by hand and the tracings were paired and averaged to create a standard template for pharyngeal tissues at each age. In addition, all 160 tracings were digitized and means and standard deviations were calculated for 29 hard and 7 soft tissue measurements. Four linear (Ar-H,S-H,Go-H, Gn-H) and three angular (N-S-H, SN-ArH,GoGn-H) measurements demonstrated that the hyoid bone descends and moves slightly anteriorly up to age 18. The soft palate (PNS-P) increased 1 mm in length and 0.5 mm in thickness every 3 years after age 9. The distance between the anterior border of the atlas (ATA) and PNS did not change after age 12, while two soft tissue measurements (PNS-pharyngeal wall [PhW2] and posterior soft palate to pharyngeal wall [psp-PhW3]) increased. In general, two periods of accelerated change (6-9 years and 12-15 years) and two periods of quiescence (9-12 years and 15-18 years) were identified for the pharyngeal soft tissues. Further studies are needed to determine in soft tissues in the oropharynx continue to change after age 18.

It is reported that some specific craniofacial characteristics are associated with obstructive sleep apnea syndrome (OSAS). To test this finding, the present study developed and assessed the feasibility of a craniofacial index score (CIS) in differentiating patients with OSAS from habitual snorers. Anthropometric measurements and lateral head radiographs were obtained on 24 male and 4 female patients with OSAS who had physician-diagnosed OSAS (respiratory disturbance index (RDI) > 20), and 25 male and 5 female habitual snorers (RDI < 20). Thirteen cephalometric and four anthropometric measurements were used in a discriminant model to construct the CIS. The model was able to correctly classify 82.1% of the OSAS group and 86.7% of the snoring group. In addition, variables that were related to the soft tissues, hyoid bone to mandibular plane, Body Mass Index, and soft palate length had the highest predictive value. These findings indicate that a CIS constructed from cephalometric and anthropometric measurements can be used to identify subjects with and without OSAS.

Among patients with sleep apnea, risk for impaired driving is highest among those with both severe excessive daytime sleepiness and historic evidence of an unintended motor vehicle crash or, by history, an equivalent level of concern. The level of apneic activity by itself is not a factor that increases risk. The high-risk individual can be recognized by pulmonary physicians who, in turn, are in a position to inform and notify the patient of increased driving risk and to explore immediate measures to reduce risk. Effective therapy needs to be instituted promptly and the effectiveness of therapy and compliance with therapy should be monitored on a routine basis. Historic information on sleepiness and driving impairment are at present the best information for medical follow-up. Among this group of high-risk patients, what is best for the patient's effective treatment is also best for society. In the opinion of the Committee, there is as yet no compelling evidence to restrict the driving privileges in apnea patients where there has not been a motor vehicle crash or an equivalent level of concern for increased driving risk. However, it is very appropriate for the physician to warn of potential dangers of driving while sleepy and inform the patient of this potential personal and social risk. Whether and under what circumstances patients with sleep apnea should be reported to the licensing authority will depend on the laws of the state in which the physician practices. in those jurisdictions in which conditions such as excessive daytime sleepiness caused by sleep apnea may be construed as reportable events, we recommend reporting to licensing bureaus if: (a) the patient has excessive daytime sleepiness and steep apnea and a history of a motor vehicle accident or equivalent level of clinical concern; and (b) one of the following circumstances exists: (i) the patient's condition is untreatable or is not amenable to expeditious treatment (within two months of diagnosis); or (ii) the patient is not willing to accept treatment or is unwilling to restrict driving until effective treatment has been instituted. Because of the imprecision of current markers of cognitive or biologic performance to prospectively identify patients at foreseeable driving risk, there can be no recommendations at this time for objective testing in patients diagnosed with or treated for sleep apnea or even for those patients presenting with either moderate or mild sleepiness. Licensing agencies are challenged to develop guidelines and mechanisms to assist in the recognition and treatment of excessive sleepiness, of which untreated sleep apnea is but one cause. The public should be advised of the dangers of driving while sleepy or extremely fatigued and educational materials developed appropriate for all operators of motor vehicles. Finally pulmonary specialists along with other medical experts familiar with sleep apnea should help formulate public policy and support reasonable regulations and behavior that will identify and treat sleepy drivers.