Hematic Cortisol and Craniofacial Morphology in Children with OSAS

Study objectives: This study wanted to evaluate the correlations between haematic cortisol levels and the craniofacial morphology in children with Obstructive Sleep Apnoea Syndrome (OSAS) in comparison with healthy children. Design/setting/patients. This is a case-control study. Children referring to the Paediatric Department, University of Insubria, Varese, in the period between 1st and 31st October 2011 for a history of disturbed sleep were evaluated and 28 children, compliant to our criteria, were enrolled in the study. Interventions: All patients underwent a full-night polysomnographic evaluation. Haematic cortisol levels were measured using a radioimmunoassay technique. An orthodontic evaluation and a cranial lateral cephalometric analysis were performed. Measurements and results: Haematic cortisol concentration at 2.00 am was found higher in OSAS patients than in controls (p<0.05). An increase in craniomandibular (p<0.05) and intermaxillar (p<0.01) angles indicated a high angle tendency in OSAS with a posterior rotation of the mandible. A retro-position of the mandible (p<0.05), an increased overjet (p<0.01) and a reduction of overbite (p<0.01) were also found. Conclusions: The altered hypothalamic-pituitary-adrenal activity and the craniofacial modification found are not enough to state if these conditions are causes rather than consequences of OSAS. Moreover cortisol and sleep fragmentation can cause a reduction of growth hormone secretion so it is possible that the alteration of facial morphology may also have a metabolic cause.