Oropharyngeal examination to predict sleep apnea severity

January 01, 0001

Oropharyngeal examination to predict sleep apnea severity

These Spanish authors evaluated the usefulness of the examination of the upper airway, paying special attention to the Friedman tongue position (FTP), to confirm obstructive sleep apnea syndrome (OSAS) and its severity in a cross-sectional study. They included 301 consecutive patients admitted to the sleep disorders unit due to suspicion of OSAS. Assessments included body mass index calculated as weight in kilograms divided by height in meters squared (BMI); neck perimeter measurement; oropharyngeal examination; fiberendoscopy; rhinomanometry; and a sleep study. Outcome measures were apnea- hypopnoea index (AHI), FTP, the uvula size, and certain complementary examinations (sex, age, BMI, cervical perimeter, nasal flow) whose importance has not been clearly established, and to explore their potential value as predictors of the AHI.

They found: "Findings included the following: the mean age of the patients was 51 years; 71.1% were male; the mean BMI was 29.8; and the mean cervical perimeter, 40.5 cm. In 94.0% of the patients the AHI value was at least 5.0/hour. Patients with FTP scores of 2 and 3 accounted for 74.1% of the whole cohort: 14.3% had an FTP score of 1, and only 11.6% had a score of 4. Of the 6.0% of cases with a normal AHI, 16 patients were classified as having FTP scores of 1, and 2 as having a score of 2. Tonsil size score, uvula score, BMI, cervical perimeter, nasal flow at 150 Pa, and age were related to OSAS severity. Curiously, AHI in patients who had undergone tonsillectomy was higher than in the TS1 group (tonsils inside the tonsillar fossa) and quite similar to the TS 2 group (tonsils that extend beyond the tonsillar pillars). In the multiple regression model, only the FTP score showed a relevant relationship to OSAS severity."

The authors concluded: "First, since the Friedman tongue position score is almost the only parameter related to OSAS severity, a simple oropharyngeal examination can provide key information on this issue. Second, tonsillectomy does not seem to protect against development of OSAS."

Examination of the upper airway doesn’t seem to be especially useful for predicting severity of sleep apnea.

For the full abstract, click here.

Arch Otolaryngol Head Neck Surg 137(10):990-996, October 2011 © 2011 to the American Medial Association
Oropharyngeal Examination to Predict Sleep Apnea Severity. Xavier Barceló, Rosa M. Mirapeix, Jordi Bugés, Albert Cobos, Christian Domingo.

Category: R. Respiratory. Keywords: sleep apnea, physical examination, upper airway, Friedman tongue position, cross-sectional study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 11 November 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.