Does Race Make a Difference in Obstructive Sleep Apnea?

The Role of Race in the Pathogenesis of Obstructive Sleep Apnea: Asians Versus Caucasians

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder, often associated with a compromised upper airway space and an increase in upper airway collapsibility. The anatomical and functional abnormalities of the upper airway play an important role in the pathogenesis of OSA. It is hypothesized that there is racial variation in the craniofacial characteristics among OSA patients. However, inter-race comparisons based on previous studies can be problematic due to variation in measurements, OSA definitions and the sample size. Besides, to our best knowledge, there is no studies that made direct inter-race comparisons in the upper airway anatomy. Therefore, studies on inter-race comparisons of the upper airway characteristics are needed to further understand the role of race in the upper airway anatomy of the OSA patients. This would provide more insights into the pathophysiology of OSA, and could result in the development of new effective treatment strategies for OSA patients.

Study Overview

• Status: Unknown
• Conditions: Obstructive Sleep Apnea of Adult
• Intervention / Treatment: Other: cone beam computed tomography

Detailed Description

1. Patient recruitment In The Netherlands, the participants will be recruited from the sleep center of the Sint Lucas Andreas hospital in Amsterdam. The protocol of recruiting the patients from The Netherlands is approved by Medical Ethic Committee of AMC with the reference number NL44085.018.13/COSH.

   In China, the participants will be recruited from the sleep disorder center of dental school of Shandong University. The protocol of recruiting patients from China is approved by Medical Ethic Committee of Shandong University.

   Patients that fit the inclusion criteria will be approached to participate in the study in both The Netherlands and China.

2. Polysomnography (PSG) For the diagnosis of OSA, all the Chinese patients included in this study will undergo an overnight PSG recording (SOMNOscreenTM Plus PSG, Randersacker, Germany) at Qilu Hospital in Jinan, while all Dutch patients included in this study will undergo an overnight PSG recording (SOMNOscreenTM Plus PSG, Randersacker, Germany) in Amsterdam.

   PSG included the following variables: electroencephalogram, electro-oculogram, leg and chin electromyograms, electrocardiogram, pulse oximetry, body position, neck microphone, nasal cannula pressure transducer, and inductive plethysmography by means of thoracic and abdominal bands. The PSG recordings will be scored manually in a standard fashion. Apnea is defined as cession of airflow ≥90% for at least 10 seconds. Hypopnea is defined as a decrease in airflow of more than 30% for at least 10 seconds, and an oxygen desaturation greater than 4%. The mean apnea-hypopnea index (AHI) of the OSA group, defined as the number of apneas and hypopneas per hour of sleep.

3. Cone beam computed tomography (CBCT) In The Netherlands, CBCT scans of the OSA patients will be made at the department of Oral Radiology at ACTA. In China, CBCT scans of the OSA patients will be made at the department of Oral Radiology at Shandong University.

   The protocol for CBCT images in The Netherlands and China will be identical and is as follows: CBCT scans will be taken in the participants with the Frankfort plane perpendicular to the floor during their awake periods. The participants will be instructed not to swallow, speak, or do any motor response other than breathing during the CBCT procedure. The image detector and beam are positioned to maximize coverage of the upper airway from the level of nasal choanae to approximately the inferior edge of the fourth cervical vertebra.

4. Anatomical modeling of the upper airway Using Amira® (v4.1, Visage Imaging Inc., Carlsbad, CA, USA), the automatic process of the upper airway segmentation will be performed following the same protocol as in previous study. First, a voxel set is built to include all of the information of the upper airway; second, a new mask is built with its thresholds ranging from -1000 to -400; and third, the superior boundary (i.e., the plane across the PNS parallel to the FH plane) and the inferior boundary (i.e., the plane across the base of the epiglottis parallel to the FH plane) of the upper airway are selected in the corresponding axial planes and put into the voxel set. Finally, all of the slices between the upper and lower boundaries are selected and put into the voxel set.
5. Statistical analysis Whether the data are normally distributed was tested by the Shapiro-Wilk W Test. The Mann-Whitney-U test (for non-normally distributed variables) or Chi-squared test (for categorical variables) and the independent t-test (for normally distributed variables) are used to compare the differences in the demographic characteristics between the Chinese and Caucasian OSA patients. Patient characteristics that are significantly different between the two groups will be used as covariate(s) in the following between-group analysis. One-way multivariate analysis of covariance (MANCOVA) is used to compare the differences in anatomical and aerodynamic characteristics between the Chinese and Caucasian OSA patients. A significance level is set at p<0.05.

• Study Type: Observational
• Enrollment (Anticipated): 50

Contacts and Locations

Study Locations

• China
  • Shandong
    • Jinan, Shandong, China, 250012
      • Recruiting
      • Dentistry
      • Contact: Hui Chen, PhD; Phone Number: +8615562661031; Email: huichen1989313@163.com
• Netherlands
  • Amsterdam, Netherlands, 4081LA
    • Recruiting
    • Dentistry
    • Contact: Ghizlane Aarab, PhD; Phone Number: 31 20 59 80802; Email: g.aarab@acta.nl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

the mild or moderate OSA patients with different racial background

Description

Inclusion Criteria:

1. 18 years and older;
2. Ability to speak, read, and write Dutch/Chinese;
3. Ability to follow-up;
4. Ability to use a computer with internet connection for online questionnaires;
5. Diagnosis with symptomatic mild or moderate OSA (5 ≤ apnea-hypopnea index (AHI) < 30);
6. Expected to maintain current lifestyle (sports, medicine, diet, etc.).

Exclusion Criteria:

1. Untreated periodontal problems, dental pain, and a lack of retention possibilities for a MAD;
2. Medication used/related to sleeping disorders;
3. Evidence of respiratory/sleep disorders other than OSA (eg. central sleep apnea syndrome);
4. Systemic disorders (based on medical history and examination; e.g. rheumatoid arthritis);
5. Temporomandibular disorders (based on the function examination of the masticatory system);
6. Medical history of known causes of tiredness by day, or severe sleep disruption (Insomnia, PLMS, Narcolepsy);
7. Known medical history of mental retardation, memory disorders, or psychiatric disorders.
8. Reversible morphological upper airway abnormalities (e.g. enlarged tonsils);
9. Inability to provide informed consent;
10. simultaneous use of other modalities to treat OSA;
11. Previous treatment with a MAD.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Chinese; Chinese mild or moderate OSA patients	Other: cone beam computed tomography; The CBCT data sets of both the Chinese and Dutch OSA patients will be obtained using a NewTom 5G CBCT system (QR systems, Verona, Italy), according to the standard imaging protocol.
Dutch; Dutch mild or moderate OSA patients	Other: cone beam computed tomography; The CBCT data sets of both the Chinese and Dutch OSA patients will be obtained using a NewTom 5G CBCT system (QR systems, Verona, Italy), according to the standard imaging protocol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the minimum cross-sectional area of the upper airway	measurement of the smallest area on the cross-sectional plane	within a week after taking CBCT scan of the patient

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the anterior-posterior dimension of CSAmin	the longest distance of CSAmin anterior-posteriorly	within a week after taking CBCT scan of the patient
the lateral dimension of CSAmin	the longest distance of CSAmin laterally	within a week after taking CBCT scan of the patient
the volume of the upper airway	the volume of the upper airway (from hard palate to the base of epiglottis)	within a week after taking CBCT scan of the patient
the length of the upper airway	the length of the upper airway (from hard palate to the base of epiglottis)	within a week after taking CBCT scan of the patient

Collaborators and Investigators

• Sponsor: Academic Centre for Dentistry in Amsterdam
• Collaborators: Shandong University

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2017
• Primary Completion (Anticipated): September 1, 2020
• Study Completion (Anticipated): December 1, 2020

Study Registration Dates

• First Submitted: March 7, 2018
• First Submitted That Met QC Criteria: March 12, 2018
• First Posted (Actual): March 13, 2018

Study Record Updates

• Last Update Posted (Actual): July 17, 2020
• Last Update Submitted That Met QC Criteria: July 15, 2020
• Last Verified: July 1, 2020

More Information

Terms related to this study

• Keywords: obstructive sleep apnea; cone beam computed tomography; race; upper airway
• Additional Relevant MeSH Terms: Nervous System Diseases; Respiratory Tract Diseases; Respiration Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Signs and Symptoms, Respiratory; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Apnea
• Other Study ID Numbers: projectnummer 530-5CDP12

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: all collected IPD, all IPD that underlie results in a publication will be shared.
• IPD Sharing Time Frame: After the papers are accepted.
• IPD Sharing Access Criteria: The data will be shared with the researchers, who is interested in our project. The types of analyses used in the projected will be share via email to the corresponding authors.
• IPD Sharing Supporting Information Type: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No