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Volume 10 No. 04
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Accepted Papers

Scientific Investigations

Comparison of BMI, AHI, and Apolipoprotein E ε4 (APOE-ε4) Alleles among Sleep Apnea Patients with Different Skeletal Classifications

Jason J. Roedig, D.M.D.1; Barbara A. Phillips, M.D., M.S.P.H, F.A.A.S.M.2; Lorri A. Morford, Ph.D.1; Joseph E. Van Sickels, D.D.S.1; Gabriel Falcao-Alencar, M.S.1; David W. Fardo, Ph.D.3; James K. Hartsfield, D.M.D., M.S., M.M.Sc., Ph.D.1,2; Xiuhua Ding, M.S.3; G. Thomas Kluemper, D.M.D., M.S.1
1College of Dentistry, University of Kentucky, Lexington, KY; 2College of Medicine, University of Kentucky, Lexington, KY; 3College of Public Health, University of Kentucky, Lexington, KY

Study Objectives:

This case-control study investigated whether variations within the APOE-ε gene were associated with having a convex facial profile (skeletal Class II) compared to exhibiting a straight or concave facial profile (Class I or Class III) among patients with obstructive sleep apnea (OSA). Associations between the apnea-hypopnea index (AHI) and body mass index (BMI) scores for these OSA patients were also examined in the context of facial profile.


OSA patients with an AHI ≥ 15 were recruited from a sleep clinic and classified by facial and dental occlusal relationships based on a profile facial analysis, lateral photographs, and dental examination. Saliva was collected as a source of DNA. The APOE1-4 allele-defining single nucleotide polymorphisms (SNPs) rs429358 and rs7412 were genotyped. A χ2 analysis was used to assess Hardy-Weinberg equilibrium and for association analysis (significance at p < 0.05). ANOVA and Fisher exact test were also used.


Seventy-six Caucasian OSA patients participated in the study—25 Class II cases and 51 non-Class II cases. There was no association of the APOE4 allele with facial profile among these OSA patients. Class II OSA patients had significantly lower BMIs (30.7 ± 5.78) than Class I (37.3 ± 6.14) or Class III (37.8 ± 6.17) patients (p < 0.001), although there was no statistical difference in AHI for Class II patients compared with other groups.


OSA patients with Class II convex profile were more likely to have a lower BMI than those in other skeletal groups. In fact 20% of them were not obese, suggesting that a Class II convex profile may influence or be associated with OSA development independent of BMI.


Roedig JJ; Phillips BA; Morford LA; Van Sickels JE; Falcao-Alencar G; Fardo DW; Hartsfield JK; Ding X; Kluemper GT. Comparison of BMI, AHI, and apolipoprotein E ε4 (APOE-ε4) alleles among sleep apnea patients with different skeletal classifications. J Clin Sleep Med 2014;10(4):397-402.

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