Correlation Between Otorhinolaryngologic Evaluation and Severity of Obstructive Sleep Apnea Syndrome in Snorers

Dreher, A.; Chaux, R. de la; Klemens, Christine A.; Werner, Robert A.; Baker, Fiona C.; Barthlen, Gabriele; Rasp, Gerd

doi:10.1001/archotol.131.2.95

Cited by 60 publications

(47 citation statements)

References 17 publications

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“…[12] In the present study, AHI and BMI had a weak correlation with ESS score (Table 3). The ESS score was normal (grade 1; <11) in most patients (57%) ( Table 2), but snoring without sleep apnea was observed in only 15% of patients and body weight was normal (BMI <25 kg/m 2 ) in only 7% of patients.…”

Section: Discussionmentioning

confidence: 42%

“…[12,16] because it was considered subjective and dependent on the patient's effort. [17] However, the Müller maneuver may be easy to perform, provide a thorough assessment of the upper airway, enable exclusion of other lesions, and be valid when marked collapse is present (Müller grade 3 or 4).…”

Section: Discussionmentioning

confidence: 99%

“…[8,12,13] Therefore, upper airway surgery such as nasal septal reconstruction and cauterization may not correct OSAHS. [11] However, the presence of a blocked nose may interfere with acceptance of and compliance with positive airway pressure therapy, and the need for higher pressure may be uncomfortable for patients.…”

Section: Discussionmentioning

confidence: 99%

“…[10,11] Previous studies have evaluated the relation between upper airway examination and severity of OSAHS. [8,12,13] Although previous studies have compared the predictive value of physical findings with polysomnography, limited information is available about the effect of obesity on the upper airway physical findings.…”

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confidence: 99%

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Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Avci¹,

Lakadamyalı²,

Büyüklü³

et al. 2017

Kulak Burun Bogaz Ihtis Derg

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Objectives: This study aims to evaluate anatomic abnormalities that may be associated with obesity and may cause sleep apnea in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by physical examination and Müller maneuver. Patients and Methods:This single center, prospective, cross-sectional study included 330 OSAHS patients (274 males, 56 females; mean age 47±11 years; range 17 to 79 years) who were performed polysomnography. Patients' clinical history as well as otolaryngology examination findings including pharyngeal soft tissues, anterior rhinoscopy and Müller maneuver were recorded. Results:Mean body mass index (BMI) was 32±5 kg/m 2 (range 21.9 to 48.4 kg/m 2 ) and apnea-hypopnea index (AHI) was 27±24 episodes per hour (range 0 to 106 episodes/hour). The AHI and BMI were statistically significantly correlated with minimum oxygen saturation, neck circumference, waist circumference, Epworth Sleepiness Scale score, retropalatal and retroglossal grades, tonsil size, and modified Mallampati score. Patients with higher AHI or BMI had statistically significantly higher retropalatal, retroglossal, and combined retropalatal and retroglossal grades (p≤0.001). Conclusion:Obesity affects the retropalatal and retroglossal grades and modified Mallampati scores of patients with OSAHS. High scores of those variables with low BMI may be attributed to upper airway soft tissue or craniofacial bony abnormalities. The retropalatal airway may narrow earlier than the retroglossal airway when fat accumulation starts in the lateral pharyngeal walls and tongue.Keywords: Müller maneuver; obesity; obstructive sleep apnea. ) ve apne-hipopne indeksi saatte 27±24 epizod (dağılım 0-106 epizod/saat) idi. Apne-hipopne indeksi ve VKİ; minimum oksijen satürasyonu, boyun çevresi, karın çevresi, Epworth Uykululuk Skalası skoru, retropalatal ve retroglossal evre, tonsil büyüklüğü ve modifiye Mallampati skoru ile istatistiksel olarak anlamlı şekilde ilişkiliydi. Apne-hipopne indeksi veya VKİ'si daha yüksek olan hastalar istatistiksel olarak daha yüksek retropalatal, retroglossal ve kombine retropalatal ve retroglossal evreye sahipti (p≤0.001).Sonuç: Obezite, OUAHS'li hastaların retropalatal ve retroglossal evrelerini ve modifiye Malampati skorlarını etkiler. Bu değişkenlere ait skorların yüksek, VKİ'nin düşük olması, üst solunum yolu yumuşak doku veya kraniyofasiyal kemik anormalliklerine bağlanabilir. Lateral farengeal duvarlarda ve dilde yağ birikimi başladığında retropalatal hava yolu, retroglossal hava yolundan önce daralabilir.Anahtar Sözcükler: Müller manevrası; obezite; obstrüktif uyku apnesi.

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Avci¹,

Lakadamyalı²,

Büyüklü³

et al. 2017

Kulak Burun Bogaz Ihtis Derg

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“…Therefore, patients with snoring should be evaluated at a minimum by a nocturnal screening test for OSA. [5] The apnea-hypopnea index (AHI) is the frequency of apnea and hypopnea episodes per hour of sleep, regardless of duration and morphology of the episodes. Patients who have similar AHI may have different duration of breathing cessation and depth of oxygen desaturation.…”

mentioning

confidence: 99%

Hypoxia parameters, physical variables, and severity of obstructive sleep apnea

Avci¹,

Avci²,

Lakadamyalı³

et al. 2016

ENT Updates

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Özet: Hipoksi parametreleri, fiziksel de¤iflkenler ve obstrüktif uyku apnesinin fliddet derecesiAmaç: Farkl› fliddet derecesinde obstrüktif uyku apnesi (OUA) olan hastalarda hipoksiyle fiziksel parametreler aras›ndaki iliflkinin belirlenmesi.Yöntem: Bu çal›flma bir gecelik polisomnografik incelemeyle de¤er-lendirilmifl 259 erkekte uygulanan retrospektif çapraz kesitsel bir ça-l›flmad›r. OUA'n›n fliddet derecesi apne/hipopne indeksine (AH‹) gö-re derecelendirildi: normal/basit horlama (n=31); hafif derecede OU-A (n=70); orta derecede OUA (n=63); fliddetli derecede OUA (n=95). Farkl› fliddet derecesinde OUA's› olan hastalar, oksijen satürasyonu <%90 (ST90) veya minimal oksijen satürasyonu (min SaO2) olan en uzun veya en k›sa toplam uyku süresine göre altgruplara ayr›ld›. Bulgular: Ortalama AH‹ 20.4 olay/saat idi. Tek de¤iflkenli analize göre ST90, AH‹ (r=0.772; p≤0.001) ve Epworth uykululuk ölçe¤i (ESS) (r=0.344; p≤0.001) ile korelasyon gösterirken min SaO2, AHI (r=-0.748; p≤0.001) ve ESS (r=-0.319; p≤0.001) ile tersine korelasyon gösterdi. Çok de¤iflkenli do¤rusal regresyon modelinde ST90 ba¤›m-s›z olarak AH‹, ESS ve boyun çevresiyle korele idi, min SaO2 ise ba¤›ms›z olarak AH‹, ESS ve vücut kitle indeksi (VK‹) ile iliflkiliydi. A¤›r derecede OUA geçiren hastalarda en düflük ve en yüksek min Sa-O2'si olan altgruplarda VK‹, modifiye Mallampati skoru, boyun ve bel çevresi ve retroglossal Müller derecesi anlaml› derecede farkl›yd›. Oksijen satürasyonu <%90 ile karakterize uyku zaman› yüzdesi (CT90) <%10 hastalarda, ST90'›n üst s›n›r› 36 dakika olup min SaO2'nin alt s›-n›r›n›n %70'ine tekabül etmekteydi. AbstractObjective: To determine the relation between hypoxia and physical parameters in patients who had different levels of severity of obstructive sleep apnea (OSA). Methods:This was a retrospective, cross-sectional study of 259 men who were evaluated with overnight polysomnography. Severity of OSA was graded based on the apnea-hypopnea index (AHI): normal/simple snoring (n=31); mild OSA (n=70); moderate OSA (n=63); severe OSA (n=95). Patients with different severity were divided into subgroups, based on having the lowest or highest values of the total sleep time with oxygen saturation <90% (ST90) or minimum oxygen saturation (min SaO2).Results: Median AHI was 20.4 events/hour. Univariate analysis showed that ST90 was correlated with AHI (r=0.772; p≤0.001) and Epworth sleepiness scale (ESS) (r=0.344; p≤0.001), and min SaO2 was inversely correlated with AHI (r=-0.748; p≤0.001) and ESS (r=-0.319; p≤0.001). Multivariate linear regression showed that ST90 was independently associated with AHI, ESS, and neck circumference, and min SaO2 was independently inversely associated with AHI, ESS, and body mass index (BMI). In patients who had severe OSA, the subgroups which had lowest and highest min SaO2 differed significantly in BMI, modified Mallampati score, neck and waist circumferences, and retroglossal Müller grade. In patients with percentage of sleep time with oxygen saturation below 90% (CT90) <10%, the upper limit o...

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Does This Patient Have Obstructive Sleep Apnea?

Myers

Mrkobrada

Simel

2013

JAMA

224

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IMPORTANCE Obstructive sleep apnea is a common disease, responsible for daytime sleepiness. Prior to referring patients for definitive testing, the likelihood of obstructive sleep apnea should be established in the clinical examination.OBJECTIVE To systematically review the clinical examination accuracy in diagnosing obstructive sleep apnea.DATA SOURCES MEDLINE and reference lists from articles were searched from 1966 to June 2013. Titles and abstracts (n = 4449) were reviewed for eligibility and appraised for evidence levels.STUDY SELECTION For inclusion, studies must have used full, attended nocturnal polysomnography for the reference standard (n = 42). MAIN OUTCOMES AND MEASURESCommunity and referral-based prevalence of obstructive sleep apnea; accuracy of symptoms and signs for the diagnosis of obstructive sleep apnea. RESULTSThe prevalence of sleep apnea in community-screened patients is 2% to 14% (sample sizes 360-1741) and 21% to 90% (sample sizes 42-2677) for patients referred for sleep evaluation. The prevalence varies based on the apnea-hypopnea index (AHI) threshold used for the evaluation (Ն5 events/h, prevalence 14%; Ն15/h, prevalence 6%) and whether the disease definition requires symptoms in addition to an abnormal AHI (Ն5/h with symptoms, prevalence 2%-4%). Among patients referred for sleep evaluation, those with sleep apnea weighed more (summary body mass index, 31.4; 95% CI, 30.5-32.2) than those without sleep apnea (summary BMI, 28.3; 95% CI, 27.6-29.0; P < .001 for the comparison). The most useful observation for identifying patients with obstructive sleep apnea was nocturnal choking or gasping (summary likelihood ratio [LR], 3.3; 95% CI, 2.1-4.6) when the diagnosis was established by AHI Ն10/h). Snoring is common in sleep apnea patients but is not useful for establishing the diagnosis (summary LR, 1.1; 95% CI, 1.0-1.1). Patients with mild snoring and body mass index lower than 26 are unlikely to have moderate or severe obstructive sleep apnea (LR, 0.07; 95% CI, 0.03-0.19 at threshold of AHI Ն15/h). CONCLUSIONS AND RELEVANCENocturnal gasping or choking is the most reliable indicator of obstructive sleep apnea, whereas snoring is not very specific. The clinical examination of patients with suspected obstructive sleep apnea is useful for selecting patients for more definitive testing.

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Correlation Between Otorhinolaryngologic Evaluation and Severity of Obstructive Sleep Apnea Syndrome in Snorers

Cited by 60 publications

References 17 publications

Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Hypoxia parameters, physical variables, and severity of obstructive sleep apnea

Does This Patient Have Obstructive Sleep Apnea?

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