Comparison of craniofacial skeletal morphology in pediatric obstructive sleep apnea-hypopnea syndrome patients with class II and class III malocclusions: a retrospective cross-sectional study

Introduction This study aimed to investigate craniofacial skeletal morphology in pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with different malocclusion types. Materials and methods A retrospective cross-sectional analysis study was conducted at Chengdu Second People's Hospital from 2023 to 2024. A total of 299 children diagnosed with OSAHS (aged 10–12 years) were included. Craniofacial structures were assessed using Jarabak and Ricketts methods. Patients were divided by malocclusion type: Class II ( n = 150, 56.7% male, mean age 11.2 ± 0.6) and Class III ( n = 149, 50.3% male, mean age 11.4 ± 0.8). Group differences in cephalometric parameters were compared using independent samples t-tests and Mann–Whitney U tests, as appropriate. Results Significant differences were found between groups. Compared to Class II, Class III patients had lower ANB angle (−2.8 ± 2.6° vs. 5.6 ± 1.9°, Cohen's d = 1.23), Wits appraisal (–2.9 ± 3.7 mm vs. 2.6 ± 0.7 mm, Cohen's d = 2.02), SN:GoMe (103.1 ± 6.0% vs. 106.7 ± 9.0%, Cohen's d = 0.48), MP/FH (32.9 ± 2.99° vs. 37.3 ± 2.65°, Cohen's d = 1.57), Xi-Pm/DC-Xi (29.3 ± 2.1° vs. 24.6 ± 3.1°, Cohen's d = 1.81), and ANS-Xi-Pm (47.8 ± 2.9° vs. 50.7 ± 2.4°, Cohen's d = 1.11) (all P < 0.05). Class III patients showed higher S-Ar:Ar-Go (75.9 ± 7.2% vs. 80.9 ± 13.0%, Cohen's d = 0.48), NP/FH (88.1 ± 2.9° vs. 83.1 ± 1.86°, Cohen's d = 2.14), Pt-Gn/Ba-N (92.2 ± 2.1° vs. 79.6 ± 2.4°, Cohen's d = 5.44), and Hy-C3 distance (5.8 ± 0.9 mm vs. 3.4 ± 0.4 mm, Cohen's d = 3.26) (all P < 0.05). No significant differences were observed in other parameters (N-S-Ar, S-Ar-Go; P > 0.05). Conclusion Distinct craniofacial skeletal patterns exist in pediatric OSAHS patients with different malocclusions. Class III patients demonstrate mandibular growth restriction with compensatory protrusion, while Class II patients display high-angle, long-face morphology with clockwise growth rotation. These findings have important clinical implications for individualized orthodontic and surgical planning in the management of pediatric OSAHS, highlighting the need for early assessment of craniofacial structure in affected children.