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Fabiola Schorr, MD; Pedro R. Genta, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Pedro R. Genta, MD, Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(6):1588-1589. doi:10.1016/j.chest.2016.04.003
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Our recent publication in CHEST (March 2016) on the craniofacial predictors of passive critical closing pressure (Pcrit) among Japanese-Brazilians and whites was commented upon by Dr Lee. We performed Pcrit measurements and upper airway CT in 78 Japanese-Brazilians and whites and showed that Pcrit is influenced by different predictors among Japanese-Brazilians and whites.

The imbalance between bony enclosure and soft tissue has been considered a major determinant of the anatomical predisposition to OSA., We showed that whites had a greater anatomical imbalance than Japanese-Brazilians and that Pcrit was associated with anatomical imbalance among whites only. Different methods have been used to describe the anatomical imbalance in OSA. We used the tongue volume/mandible volume ratio as described previously by Shigeta et al. Mostafiz et al measured the tongue cross-sectional area/oral enclosure ratio. We agree with Dr Lee that the ratio between tongue and mandibular enclosure volume is an additional method to describe the anatomical imbalance in OSA. In a previous report by Lee et al, anatomical imbalance was measured by still another method obtained from two-dimensional cephalograms: BMI/mandible size ratio. Therefore, different approaches have been used to describe the anatomical imbalance in OSA. We are not aware that there is a gold standard method.

Mandibular volume in our study was measured from CT scans using a bone segmentation technique, which is rather accurate and has been used before., Although Japanese-Brazilians had a shorter mandible length, mandible height was higher when compared with whites (marginal P value = .07). The higher mandible height among Japanese-Brazilians as compared with whites observed in our study is consistent with a previous report. Figure 1 of our paper characterizes well the shorter mandible length, larger mandible height, larger mandible volume, and smaller tongue volume of the Japanese-Brazilian subject as compared with the white subject. For these reasons, we believe that our observations on the mandibular dimensions and anatomical imbalance among Japanese-Brazilians and whites are consistent. We support further studies to explore the upper airway anatomical characteristics leading to OSA.

References

Schorr F. .Kayamori F. .Hirata R.P. .et al Different craniofacial characteristics predict upper airway collapsibility in Japanese-Brazilian and white men. Chest. 2016;149:737-746 [PubMed]journal. [CrossRef] [PubMed]
 
Mostafiz W. .Dalci O. .Sutherland K. .et al Influence of oral and craniofacial dimensions and mandibular advancement splint treatment outcome in patients with obstructive sleep apnea. Chest. 2011;139:1331-1339 [PubMed]journal. [CrossRef] [PubMed]
 
Shigeta Y. .Ogawa T. .Ando E. .et al Influence of tongue/mandible volume ratio on oropharyngeal airway in Japanese male patients with obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:239-243 [PubMed]journal. [CrossRef] [PubMed]
 
Lee R.W.W. .Vasudavan S. .Hui D.S. .et al Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep. 2010;33:1075-1080 [PubMed]journal. [PubMed]
 
Tomoyasu Y. .Yamaguchi T. .Tajima A. .et al Further evidence for an association between mandibular height and the growth hormone receptor gene in a Japanese population. Am J Orthod Dentofacial Orthop. 2009;136:536-541 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Schorr F. .Kayamori F. .Hirata R.P. .et al Different craniofacial characteristics predict upper airway collapsibility in Japanese-Brazilian and white men. Chest. 2016;149:737-746 [PubMed]journal. [CrossRef] [PubMed]
 
Mostafiz W. .Dalci O. .Sutherland K. .et al Influence of oral and craniofacial dimensions and mandibular advancement splint treatment outcome in patients with obstructive sleep apnea. Chest. 2011;139:1331-1339 [PubMed]journal. [CrossRef] [PubMed]
 
Shigeta Y. .Ogawa T. .Ando E. .et al Influence of tongue/mandible volume ratio on oropharyngeal airway in Japanese male patients with obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:239-243 [PubMed]journal. [CrossRef] [PubMed]
 
Lee R.W.W. .Vasudavan S. .Hui D.S. .et al Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep. 2010;33:1075-1080 [PubMed]journal. [PubMed]
 
Tomoyasu Y. .Yamaguchi T. .Tajima A. .et al Further evidence for an association between mandibular height and the growth hormone receptor gene in a Japanese population. Am J Orthod Dentofacial Orthop. 2009;136:536-541 [PubMed]journal. [CrossRef] [PubMed]
 
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