The Prognostic Value of Simulated Snoring in Awake Patients With Suspected Sleep-Disordered Breathing: Introduction of a New Technique of Examination

Herzog, Michael; Metz, Till; Schmidt, Andreas; Bremert, Thomas; Venohr, Beatrice; Hosemann, Werner; Kaftan, Holger

doi:10.1093/sleep/29.11.1456

Cited by 31 publications

(25 citation statements)

References 28 publications

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“…Recent publications, however, revealed a more skeptical point of view [23][24][25], which might be reflected in the low overall score in this study. Contrary to the Mueller maneuver, an increase in the collapsibility of the upper airway structure during simulated snoring has recently been reported to correlate with obstructive nocturnal events [26,27]. Nevertheless, in our evaluation, simulated snoring did not achieve a high overall mSOR, which might be explained by the novelty of the examination.…”

Section: Discussioncontrasting

confidence: 86%

Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing

Plößl

Herzog

Glien

et al. 2015

Eur Arch Otorhinolaryngol

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There is currently no standardized ear, nose, and throat (ENT) clinical examination for patients with sleep-disordered breathing (SDB). As a result, there are large inter-individual differences in the examinations due to an inadequate estimation of the relevance of certain anatomic sites. We aimed to identify which examinations/dynamic tests are considered most relevant by German ENT physicians. A questionnaire was designed, evaluating 23 anatomic sites/dynamic tests of the upper aero-digestive tract. The questionnaire was sent to all German ENT departments (n = 153), including universities and other tertiary or secondary referral centers, by postal mail. In addition, almost all private ENT specialists registered with the German professional association (n = 2496) were contacted via e-mail. Participants assessed how often they examined the sites/dynamic tests, subjective importance, and the impact on the therapeutic procedure. A mean score of relevance (mSOR) was generated (minimum score 1; maximum score 75) from these three items. The response rate for hospitals was 58.8 %; while, it was 4.1 % for ENT specialists in private practice. Therefore, the total response rate was 7.3 %. Of the 23 assessed items, some showed a high overall relevance, such as the tonsils (mSOR 64.75), webbing (mSOR 58.14), uvula (mSOR 55.12), or tongue base (mSOR 53.99). Other examinations, such as simulated snoring (mSOR 19.34) or the Mueller maneuver (mSOR 18.98), were estimated as less relevant. Our data reflect the assessment of German otorhinolaryngologists on the clinical examination of SDB patients. The results should be considered as a basis for compiling a standardized procedure.

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Section: Discussioncontrasting

confidence: 86%

Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing

Plößl

Herzog

Glien

et al. 2015

Eur Arch Otorhinolaryngol

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“…23 There are several adult studies with mixed results regarding the utility of Mallampati score in predicting OSA. [24][25][26][27][28][29][30][31] There have been no studies in the pediatric population looking at the clinical use of Mallampati score to predict obstructive sleep apnea and its severity.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Mallampati Score and Pediatric Obstructive Sleep Apnea

Kumar

Schroeder

Zhang

et al. 2014

Journal of Clinical Sleep Medicine

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“…The authors report a shift of obstruction patterns from lateral under awake condition towards circular or anterior-posterior patterns under DISE. Apart from the Müller manoeuvre, SimS has been reported to serve as an alternative non-invasive way to examine the upper airway under semi-dynamic conditions [1,12]. A diagnostic agreement between SimS and Müller manoeuvre was stated for retroglossal obstruction [18].…”

Section: Discussionmentioning

confidence: 99%

“…The procedure was described in detail previously [12]. Briefly, the patients were examined under wake conditions in a supine position by flexible nasal endoscopy.…”

Section: Simulated Snoringmentioning

confidence: 99%

Drug-induced sleep endoscopy and simulated snoring in patients with sleep-disordered breathing: agreement of anatomic changes in the upper airway

Herzog

Kellner

Plößl

et al. 2015

Eur Arch Otorhinolaryngol

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Drug-induced sleep endoscopy (DISE) and simulated snoring (SimS) are performed as part of the diagnostic procedure in patients with suspected sleep-disordered breathing (SDB). Despite both techniques frequently performed, they have rarely been evaluated yet in terms of agreement of the obtained results. Both diagnostic procedures were performed consecutively in 40 patients with SDB and documented identically. The obtained data were analysed with respect to the agreement of both procedure at different levels of the oropharynx as well as different patterns of obstruction and vibration. The anterior-posterior collapsibility of the soft palate/uvula revealed a moderate agreement between SimS and DISE (κ = 0.42; 95 % CI 0.22-0.63). The dorsal shift of the tongue base agreed moderate for patients with an AHI below 10 (κ = 0.47) and above 25 (κ = 0.44) between SimS ad DISE. The lateral and circular pharyngeal collapsibility at velum and tongue base level did not agree between SimS and DISE, was higher for DISE and could be partially reversed by mandibular protrusion. Collapse patterns of the soft palate and uvula can be induced by SimS and resemble the patterns induced by DISE. The dorsalization of the tongue base can be simulated to a lower extent by SimS. Lateral and circular patterns of collapse at the upper and lower oropharynx induced by DISE do not seem to be simulated by SimS. SimS seems to be an additional method to screen the collapsibility of the soft palate and uvula prior to DISE.

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The Prognostic Value of Simulated Snoring in Awake Patients With Suspected Sleep-Disordered Breathing: Introduction of a New Technique of Examination

Abstract: The "dynamic" examination of the upper airway under simulated snoring in awake patients is an easy-to-perform method to predict the probability of SDB prior to nighttime polysomnography.

Cited by 31 publications

References 28 publications

Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing

Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing

Mallampati Score and Pediatric Obstructive Sleep Apnea

Drug-induced sleep endoscopy and simulated snoring in patients with sleep-disordered breathing: agreement of anatomic changes in the upper airway

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