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Volume 14 No. 07
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Accepted Papers

Scientific Investigations

Craniofacial Phenotyping in Chinese and Caucasian Patients With Sleep Apnea: Influence of Ethnicity and Sex

Kate Sutherland, PhD1,2; Richard W.W. Lee, MBBS, PhD3,4; Tat On Chan, MSc, RPSGT5; Susanna Ng, MBChB5; David S. Hui, MBBS, MD5; Peter A. Cistulli, MBBS, PhD1,2
1Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia; 2Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia; 3Department of Respiratory Medicine, Gosford Hospital, Gosford and School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; 4Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; 5Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong

Study Objectives:

Craniofacial abnormalities are a risk factor for obstructive sleep apnea (OSA). We have previously shown that phenotypic information derived from craniofacial photographs predict OSA in sleep clinic populations. However, there are likely ethnic and sex differences in craniofacial phenotypes related to OSA. We aimed to assess the use of craniofacial photography to identify interactions between OSA, ethnicity, and sex in craniofacial phenotype.


Frontal and profile craniofacial photographs were analyzed from two sleep clinic populations of different ethnicity (Hong Kong Chinese, Australian Caucasians). OSA was defined as apnea-hypopnea index (AHI) > 10 events/h. Ten craniofacial measurements (three angles relating to jaw position and seven ratios describing proportions of the face) were examined for interactions between OSA status and sex or ethnicity) using factorial analysis of variance.


A total of 363 subjects (25% female) were included (n = 200 Chinese, n = 163 Caucasian), of which 33% were controls. There were two-way interactions for OSA with both sex (mandibular plane angle [F = 7.0, P = .009], face / eye width ratio [F = 4.7, P = .032], maxillary / mandibular volume ratio [F = 9.2, P = .003]) and ethnicity (face / nose width ratio [F = 4.0, P = .045], mandibular width / length ratio [F = 5.1, P = .024], maxillary / mandibular volume ratio [F = 11.0, P = .001]).


We provide evidence of ethnic and sex differences in facial phenotype related to OSA. Furthermore, we demonstrate that craniofacial photography can be used as a phenotypic tool to assess these differences and allow investigation of OSA phenotypes in large samples. This has relevance to personalizing OSA recognition strategies across different populations.


Sutherland K, Lee RW, Chan TO, Ng S, Hui DS, Cistulli PA. Craniofacial phenotyping in Chinese and Caucasian patients with sleep apnea: influence of ethnicity and sex. J Clin Sleep Med. 2018;14(7):1143–1151.

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