Clinical Context Missing from Association of Transverse Maxillary Dimensions and Upper Airway Collapsibility
Notice bibliographique
Résumé
It was with great interest that I recently read the study by Thuler et al.,1 Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility during Drug-Induced Sleep Endoscopy in the August 2023 issue of Otolaryngology–Head and Neck Surgery, where craniofacial measurements derived from computed tomography analysis of 103 adults with obstructive sleep apnea were related to indices of pharyngeal collapsibility derived from positive airway pressure titration during drug induced sleep endoscopy. The characterization and treatment of the transverse dimension of the maxilla and the relationship to upper airway function has long been an area of attention in the field of orthodontics. However, despite the eye-catching title, closer examination of the data presented in the paper makes it clear that significant uncertainty remains in our ability to predict upper airway collapsibility based on measurements of a patient's craniofacial anatomy. The authors state that skeletal dimensions may serve as anatomic markers for pharyngeal collapsibility, and perhaps guide patient selection for treating anatomic deficiencies. However, to translate the present findings clinically some important study limitations need to be considered. First, despite the significant manipulation of the DICOM files and the subsequent subjective landmark identification required, the reliability of the methods used for computed tomography analysis described is unknown. No repeat measures or intra or inter-examiner reliability were reported. Second, while the beta coefficient and standardized beta association data were presented, the clinical significance of these associations cannot be determined without the accompanying mean and standard deviation data for the various craniofacial measurements of the sample population. Providing the standard deviation numbers for Pcrit and intermolar distance (IMD) of the sample population would allow readers to determine if the weak standardized beta relating these variables has any clinical relevance. Additionally, reporting the skeletal and dental measurements of the sample population would help relate these results to past and future similar studies. The emphasis on the transverse dimension of the maxilla is curious considering that of the variables reported to be significant, intermolar (IMD) or interpremolar (IMPD) width presented among the lowest standardized beta effects. The strength of conclusions is further limited as while IMD and IPMD are both assessments of the transverse dimension of the maxilla, only IMD was significantly associated with Pcrit and only IMPD was associated with PhoP. Is there a physiologic explanation for why both IMD and IMPD would not both be significantly related to both measures of pharyngeal collapsibility (Pcrit and PhoP) if the proposed association between the transverse dimension of the maxilla and pharyngeal collapsibility was valid? Benjamin T. Pliska, is entirely responsible for the idea and writing of this letter to the editor. None. None.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».