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The Turkish Journal of Ear Nose and Throat

2602-4837

Istanbul University

Otorhinolaryngologic examination in obstructive sleep apnea syndrome: the correlation between the severity of sleep disorder and physical examination

Tıkayıcı uyku apne sendromunda kulak burun boğaz muayenesi: Uyku bozukluğunun şiddeti ve fiziki muayene arasındaki ilişki

Acar

Baran

Department of Otolaryngology, Keçiören Training and Research Hospital, Ankara, Turkey Babademez

Mehmet Ali

Department of Otolaryngology, Keçiören Training and Research Hospital, Ankara, Turkey Karabulut

Hayriye

Department of Chest Surgery, Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey Çiftçi

Bülent

Department of Otolaryngology, Keçiören Training and Research Hospital, Ankara, Turkey Günbey

Emre

Department of Otolaryngology, Keçiören Training and Research Hospital, Ankara, Turkey Karaşen

Rıza Murat

Department of Otolaryngology, Keçiören Training and Research Hospital, Ankara, Turkey

10 23 2009

19 5 246 252

1990

The Turkish Journal of Ear Nose and Throat

Objectives: The aim of this study was to compare nasopharyngeal examination findings with those of polysomnography, which is considered to be the gold standard, in positional and nonpositional obstructive sleep apnea syndrome OSAS patients. Patients and Methods: The study included 374 patients 215 males, 159 females; mean age 44.9 years; range 11 to 77 years presenting with OSAS or simple snoring. Patients underwent polysomnography recordings and otorhinolaryngologic examination including fiberoptic nasopharyngoscopy with the Müller maneuver. The correlation of the data scoredwith the polysomnographic findings and body mass index BMI was investigated. The findings were assessed using the Mann Whitney U-test anatomic findings and Student t-test Müller maneuver . Results: Body mass index was correlated with apnea-hypopnea index AHI , AHI-Lateral AHI-supine, the grade of the tongue base and neck circumference p

Amaç: Bu çalışmada pozisyonel ve pozisyonel olmayan tıkayıcı uyku apne sendromlu TUAS hastalar için altın standart olarak kabul edilen polisomnografi ve nazofarengeal muayene bulguları karşılaştırıldı.Hastalar ve Yöntemler: Bu çalışmaya TUAS veya basit horlama tanılı 374 hasta 215 erkek, 159 kadın; ort. yaş 44.9 yıl; dağılım 11-77 yıl dahil edildi. Polisomnografi kayıtları alınan hastaların, kulak burun boğaz muayeneleri ile Müller manevrasını da içeren fiberoptik nazofarengoskopik muayeneleri yapıldı. Skorlanan bu verilerin polisomnografi bulguları ve vücut kütle indeksleri VKİ ile ilişkisi araştırıldı. Sonuçlar Mann Whitney U-testi anatomik bulgular ve Student t-testi Müller manevrası kullanılarak değerlendirildi.Bulgular: Vücut kütle indeksleri ile apne hipopne indeksi AHİ , AHİ-lateral, AHİ-supin, dil kökü büyüklüğü ve boyun kalınlığı arasında ilişki bulundu p

Müller maneuver polysomnography sleep apnea sleep position

Müller manevrası polisomnografi uyku apnesi uyku pozisyonu

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.

Gislason T, Almqvist M, Eriksson G, Taube A, Boman G. Prevalence of sleep apnea syndrome among Swedish men-an epidemiological study. J Clin Epidemiol 1988; 41:571-6.

Sher AE, Thorpy MJ, Shprintzen RJ, Spielman AJ, Burack B, McGregor PA. Predictive value of Müller maneuver in selection of patients for uvulopalatophar- yngoplasty. Laryngoscope 1985;95:1483-7.

Aboussouan LS, Golish JA, Wood BG, Mehta AC, Wood DE, Dinner DS. Dynamic pharyngoscopy in predicting outcome of uvulopalatopharyngoplasty for moderate and severe obstructive sleep apnea. Chest 1995;107:946-51.

Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifica- tions. 1st ed. Westchester: American Academy of Sleep Medicine; 2007.

Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, Caldarelli D. Clinical predic- tors of obstructive sleep apnea. Laryngoscope 1999; 109:1901-7.

Dreher A, de la Chaux R, Klemens C, Werner R, Baker F, Barthlen G, et al. Correlation between otorhinolar- yngologic evaluation and severity of obstructive sleep apnea syndrome in snorers. Arch Otolaryngol Head Neck Surg 2005;131:95-8.

Viner S, Szalai JP, Hoffstein V. Are history and physi- cal examination a good screening test for sleep apnea? Ann Intern Med 1991;115:356-9.

Zonato AI, Bittencourt LR, Martinho FL, Jşnior JF, Gregório LC, Tufik S. Association of systematic head and neck physical examination with sever- ity of obstructive sleep apnea-hypopnea syndrome. Laryngoscope 2003;113:973-80.

Borowiecki B, Pollak CP, Weitzman ED, Rakoff S, Imperato J. Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep-apnea syndrome. Laryngoscope 1978;88:1310-3.

Katsantonis GP, Maas CS, Walsh JK. The predictive efficacy of the Müller maneuver in uvulopalatophar- yngoplasty. Laryngoscope 1989;99:677-80.

Terris DJ, Hanasono MM, Liu YC. Reliability of the Muller maneuver and its association with sleep-disor- dered breathing. Laryngoscope 2000;110:1819-23.

Kim HY, Bok KH, Dhong HJ, Chung SK. The correla- tion between pharyngeal narrowing and the severity of sleep-disordered breathing. Otolaryngol Head Neck Surg 2008;138:289-93.

Hori Y, Shizuku H, Kondo A, Nakagawa H, Kalubi B, Takeda N. Endoscopic evaluation of dynamic narrow- ing of the pharynx by the Bernouilli effect producing maneuver in patients with obstructive sleep apnea syndrome. Auris Nasus Larynx 2006;33:429-32.

Pang KP, Terris DJ, Podolsky R. Severity of obstruc- tive sleep apnea: correlation with clinical examination and patient perception. Otolaryngol Head Neck Surg 2006;135:555-60.

Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med 1997;127:581-7.

Dixon JB, Schachter LM, O’Brien PE. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest 2003; 123:1134-41.

Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 2002;127:13-21.

Rodenstein DO, Dooms G, Thomas Y, Liistro G, Stanescu DC, Culée C, et al. Pharyngeal shape and dimensions in healthy subjects, snorers, and patients with obstructive sleep apnoea. Thorax 1990;45:722-7.

Pevernagie DA, Stanson AW, Sheedy PF 2nd, Daniels BK, Shepard JW Jr. Effects of body position on the upper airway of patients with obstructive sleep apnea. Am J Respir Crit Care Med 1995;152:179-85.

Nakano H, Ikeda T, Hayashi M, Ohshima E, Onizuka A. Effects of body position on snoring in apneic and nonapneic snorers. Sleep 2003;26:169-72.

Woodson BT, Naganuma H. Comparison of methods of airway evaluation in obstructive sleep apnea syn- drome. Otolaryngol Head Neck Surg 1999;120:460-3.

Acar B, Karabulut H, Babademez MA, Ciftci B, Karasen RM. Evaluation of submucosal minimally invasive lin- gual excision technique for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2009;140:281.

Suratt PM, McTier RF, Wilhoit SC. Upper airway mus- cle activation is augmented in patients with obstruc- tive sleep apnea compared with that in normal sub- jects. Am Rev Respir Dis 1988;137:889-94.

Mezzanotte WS, Tangel DJ, White DP. Waking genio- glossal electromyogram in sleep apnea patients ver- sus normal controls (a neuromuscular compensatory mechanism). J Clin Invest 1992;89:1571-9.

Douglas NJ, Jan MA, Yildirim N, Warren PM, Drummond GB. Effect of posture and breathing route on genioglossal electromyogram activity in normal subjects and in patients with the sleep apnea/hypo- pnea syndrome. Am Rev Respir Dis 1993;148:1341-5.

Lavie P, Gertner R, Zomer J, Podoshin L. Breathing disorders in sleep associated with “microarousals” in patients with allergic rhinitis. Acta Otolaryngol 1981; 92:529-33.

McNicholas WT, Tarlo S, Cole P, Zamel N, Rutherford R, Griffin D, et al. Obstructive apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis 1982;126:625-8.

Miljeteig H, Savard P, Mateika S, Cole P, Haight JS, Hoffstein V. Snoring and nasal resistance during sleep. Laryngoscope 1993;103:918-23.

Atkins M, Taskar V, Clayton N, Stone P, Woodcock A. Nasal resistance in obstructive sleep apnea. Chest 1994;105:1133-5.

Cuhadaroglu C, Keles N, Erdamar B, Aydemir N, Yucel E, Oguz F, et al. Body position and obstructive sleep apnea syndrome. Pediatr Pulmonol 2003;36:335-8.