Craniofacial photography and association with sleep-disordered breathing severity in children

Purpose: Sleep-disordered breathing (SDB) in children has been associated with craniofacial characteristics. Facial photography provides a radiation-free means of estimating facial morphology through facial landmark analysis. Our objective was to determine whether facial analysis provides information about SDB severity. Specifically, we aimed to determine whether facial photographic measurements differ with SDB status, or were associated with SDB severity. Methods: Single-center cohort of children undergoing overnight polysomnography for assessment of SDB; non-snoring controls were recruited from the community to undergo polysomnography. Standardized front and lateral facial photographs were analyzed according to previously published protocols. Multivariate analysis of variance was used to determine if facial measurements differed between SDB groups and controls. Linear regression was performed to determine if facial measurements were associated with SDB severity. Results: Seventy-eight children (9 controls, 17 primary snoring, 23 mild SDB, 27 moderate-severe SDB) were included. Facial angles and upper-to-lower face height ratio showed variation between SDB groups (p = 0.038). Facial measurements related to SDB severity, specifically an increased cervicomental angle (p = 0.001), and increased lower-to-upper face height (p = 0.006). Conclusion: Evaluation of craniofacial features using clinical photography is feasible. Preliminary investigation shows some relationship with SBD severity. Further work is needed to determine if craniofacial photography is useful for stratifying SDB risk in children.