Clinical Context Missing from Association of Transverse Maxillary Dimensions and Upper Airway Collapsibility
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".