Reliability of the Muller Maneuver and Its Association With Sleep‐Disordered Breathing

Abstract

Objectives/Hypothesis: Use of the Muller maneuver (MM) in the evaluation of patients with obstructive sleep apnea is controversial. One criticism of this test is that it is somewhat subjective. Our objective is to explore the reliability of this technique and its association with sleep-disordered breathing. Study Design: Prospective study performed in an academic tertiary care center. Methods: An analysis of MM scores from 180 consecutive patients obtained independently by two examiners was completed. These scores were compared with each other and with the apnea-hypopnea index (AHI) obtained from polysomnographic studies. Results: Collapse of the soft palate (PAL), lateral pharyngeal wall (LPW), and base of the tongue (BOT) was rated on a five-point scale (0 -4). The mean scores determined by the faculty examiner were 2.47, 2.06, and 1.58, respectively; the mean scores determined by the resident examiner were 2.34, 2.25, and 1.48, respectively. The scores of the two examiners correlated to within ؎1 unit 83.9% of the time at the PAL, 91.1% at the LPW, and 85.0% at the BOT. The degree of correlation was not influenced by year of training of the resident. When the AHI was converted to a four-point scale based on severity, the score correlated within ؎1 of the average MM score 72.1% of the time. Conclusions: Despite the subjective nature of the MM, the five-point scale can be used by independent examiners to achieve an evaluation of the upper airway that is reproducible. The preoperative severity of sleep-disordered breathing based on the AHI is moderately correlated with the MM score. Key Words: Sleep-disordered breathing, obstructive sleep apnea, Muller maneuver, inter-rater reliability.

Respiratory Variables During Wakefulness in Patients with Obstructive Sleep Apnea and Associations with Anthropometric Measurements

“…But only the value of pharyngeal collapse with Muller maneuver was strongly correlated with AHI (Table 4). To our knowledge, it was the most predicting factor for OSAS confirming the previous studies (5,(33)(34)(35). Nasal continuous positive airway pressure is effective in moderate to severe OSAS patients (36).…”

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

“…[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). [18] In the present study, all otolaryngology examinations were performed and graded by the same otolaryngologist, and the otolaryngology evaluation was performed in consultation with a pulmonologist. More reliable associations may be observed in a study with two independent examiners (each examiner blinded to the score of the other).…”

Correlation Between Retropalatal Collapse as Observed During Muller’s Maneuver to Severity of OSA

“…In a study of 180 patients done by Terris et al [2] checked the reliability of Muller's in OSA. The authors concluded that despite the subjective nature of the MM, the five-point scale can be used by independent examiners to achieve an evaluation of the upper airway that is reproducible.…”

“…These methods include manometry, radiographic studies including computed tomography, dynamic MRI, fluoroscopy and cephalometry and office procedure such as the Muller's maneuver (MM) [2]. MM has been used widely by clinicians during the pre operative evaluation of patients diagnosed with OSA.…”

“…MM has been used widely by clinicians during the pre operative evaluation of patients diagnosed with OSA. A review of literature shows positive correlation between MM and retro palatal collapse [2,3]. Trudo et al have demonstrated that retropalatal airway volume is significantly reduced during sleep, retroglossal volume remains unchanged in comparisons of sleep and wakefulness [4].…”