Interexaminer agreement of Friedman tongue positions for staging of obstructive sleep apnea/hypopnea syndrome

Friedman, Michael; Soans, Rohit; Gürpınar, Berk; Lin, Hsin‐Ching; Joseph, Ninos J.

doi:10.1016/j.otohns.2008.06.017

Cited by 38 publications

(48 citation statements)

References 13 publications

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“…A high interexaminer agreement has been reported for tonsil size and tongue position with an interclass correlation coefficient of 0.89 and 0.93, respectively . This is in agreement with the findings of Friedman et al for the tongue position . Ng et al showed that interexaminer agreement in evaluating tonsil size using the Brodsky grading scale is very high .…”

Section: Discussionsupporting

confidence: 87%

Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea

Tschopp

2019

The Laryngoscope

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Objectives/Hypothesis To investigate the relationship of tonsil volume and grade on outcomes of uvulopalatopharyngoplasty (UPPP) with tonsillectomy in patients with obstructive sleep apnea (OSA). Study Design Retrospective cohort analysis. Methods Data of 70 consecutive patients undergoing UPPP with tonsillectomy between 2015 and 2018 were analyzed. Patients with an apnea‐hypopnea index (AHI) <10/hr or concomitant surgery other than nasal surgery were excluded. Tonsil volume was measured intraoperatively. Preoperatively and 3 months after surgery we assessed the AHI using respiratory polygraphy, daytime sleepiness using the Epworth Sleepiness Scale (ESS), and a visual analog scale for the snoring index (SI). Results Tonsil grade and volume both showed a significant correlation with preoperative AHI. Postoperative AHI was not significantly different between grades and volume. The AHI reduction after surgery increased significantly with larger volume and higher tonsil grade. For all grades, the postoperative ESS was significantly reduced compared to the preoperative value, but was not significantly correlated with tonsil volume. Preoperative and postoperative SI was not significantly correlated between tonsil grade or volume. In all grades, SI was significantly reduced after surgery. Conclusions In our study, we found that large tonsils are responsible for higher preoperative AHI values, and their removal leads to greater reduction of initial AHI. However, the postoperative effect on daytime sleepiness and snoring reduction is not significantly correlated with tonsil size and volume, indicating that these parameters are mainly influenced by other factors. The knowledge of the significance of tonsil size and volume is important for ear, nose, and throat physicians when counseling OSA patients. Level of Evidence 2c Laryngoscope, 129:E449–E454, 2019

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Section: Discussionsupporting

confidence: 87%

Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea

Tschopp

2019

The Laryngoscope

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“…Tonsil grade and uFTP are subjective grading systems, and interexaminer variability must be considered. Ng et al demonstrated the acceptable intraexaminer and interexaminer reproducibility of tonsil size grading, whereas Friedman et al demonstrated a high level of interexaminer agreement of uFTP by kappa statistical analysis and validated the widespread clinical use of uFTP reliably and accurately . Second, the differences in physiologic monitoring methods used in different sleep centers may have some impact on PSG results, affecting the AHI part of the equation presented in results.…”

Section: Discussionmentioning

confidence: 99%

“…Tonsil size grading was classified by two clinicians using the Friedman scale as follows: 0, surgically removed tonsils; 1, tonsils hidden within the pillars; 2, tonsils extending to the pillars; 3, tonsils were beyond the pillars but not to the midline; and 4, tonsils extended to the midline. The anatomical relationships between the tongue and tonsils/pillar, uvula, soft palate, and hard palate were also evaluated by uFTP . The uvular length was measured from the base to the distal free end of the uvula on the midline by using a straight long caliper, with the subject sitting in an upright position with mouth open and tongue inside.…”

Section: Methodsmentioning

confidence: 99%

“…The anatomical relationships between the tongue and tonsils/pillar, uvula, soft palate, and hard palate were also evaluated by uFTP. 14 The uvular length was measured from the base to the distal free end of the uvula on the midline by using a straight long caliper, with the subject sitting in an upright position with mouth open and tongue inside. Neck circumference (NC) was measured in centimeters just below the laryngeal prominence, with the head positioned in the Frankfort horizontal plane.…”

Section: Methodsmentioning

confidence: 99%

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Clinical predictors of effective continuous positive airway pressure in patients with obstructive sleep apnea/hypopnea syndrome

et al. 2015

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“…Prior patient study is of easy clinical applicability. Friedman recently published a study showing that the Friedman classification has a high inter-examiner correlation, being useful to assess patients in research and teaching settings 14 . These results point to the importance of a proper UAW investigation in the pre-op evaluation of all patients with SOAS.…”

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confidence: 99%

Correlação entre a classificação de Friedman e Índice de Apneia-Hipopneia em portadores de Síndrome da Apneia e Hipopneia Obstrutiva do Sono

Rodrigues¹,

Dibbern²,

Goulart³

et al. 2010

Braz. j. otorhinolaryngol. (Impr.)

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OSAHS is an important disease in current medical settings because of its association with chronic cardiovascular diseases and socioeconomic impacts.Aims: to establish the correlation between the Friedman Classification and the OSAHS severity through the Apnea-Hypopnea Index) in patients with OSAHS for assessment and surgery purposes. Materials and Methods:Cross-sectional study. We evaluated and classified 143 patients, using the Epworth's and Friedman's scale and OSAHS severity according to the AHI.Results: 112 patients were submitted to polysomnography. We compared the Friedman Score and the IAH. The variables were associated with p<0.05. We found that patients with light OSAHS, tended to have a lower Friedman classification (better surgical result). By the same token, patients with moderate to severe OSAHS had a greater prevalence of Friedman's score of III and IV; p< 0.05 (lower success rates from uvulopalatopharyngoplasty). Conclusion:We conclude that the Friedman's classification correlates with OSAHS severity -the higher the Friedman's score, the more severe is the OSAHS. Braz J Otorhinolaryngol. 2010;76(5):557-60. ORIGINAL ARTICLE BJORL

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Interexaminer agreement of Friedman tongue positions for staging of obstructive sleep apnea/hypopnea syndrome

Abstract: The strong interexaminer correlation of FTP demonstrated by this study indicates that FTP may be a useful adjunct in describing hypopharyngeal anatomy in patients with OSAHS.

Cited by 38 publications

References 13 publications

Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea

Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea

Clinical predictors of effective continuous positive airway pressure in patients with obstructive sleep apnea/hypopnea syndrome

Correlação entre a classificação de Friedman e Índice de Apneia-Hipopneia em portadores de Síndrome da Apneia e Hipopneia Obstrutiva do Sono

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