Can the Müller maneuver detect multilevel obstruction of the upper airway in patients with obstructive sleep apnea syndrome?

Year 2010, Volume: 20 Issue: 2, 84 - 88, 20.03.2010

Ümit Tunçel Hasan Mete İnançlı Şefik Sinan Kürkçüoğlu Murat Enöz

Abstract

Objectives: Our aim is to figure out the role of Müller maneuver MM to detect the level of upper airway obstruction and the severity of obstructive sleep apnea syndrome OSAS . Patients and Methods: In this study, polysomnographies were made after the routine otorhinolaryngological examination including MM in patients admitted with OSAS suspicion in Ankara Oncology Training and Research Hospital’s Department of Otorhinolaryngology, Sleep Medicine Policlinic. Two-hundred and twenty-one OSAS patients 142 males, 179 females; mean age 47.63 years; range 18 to 82 years were included to the study. Results: There weren’t any significant correlation among apnea hypopnea index AHI results and body mass index BMI , tonsil size and obstruction severity due to MM p>0.05 . Müller maneuver scores are positively correlated to the Epworth sleepiness scale EPSS scores r=0.213 and p<0.001 . Epworth sleepiness scale scores are found to be correlated to BMI and neck circumference p<0.05 . Level of the airway obstruction doesn’t affects the EPSS scores p=0.235 . Also EPSS scores are not affected from uni or multilevel obstruction p=0.088 . Conclusion: The severity of the MM score is not correlated to the severity of OSAS according to AHI results, but it is found to be correlated to EPSS. Vibrating tissues caused local and systemic inflammation in OSAS patients. The correlation between EPSS and MM scores can be explained by this inflammatory process. Further prospective studies have to be done in this field. Müller maneuver in an awake patient might reflect the levels of the obstruction in sleep conditions even though insufficient for figuring out the severity of OSAS.

Keywords

Müller maneuver, obstructive sleep apnea syndrome, uvulopalatopharyngoplasty, videoendoscopy

Obstrüktif uyku apneli hastalarda Müller manevrasıyla üst hava yolunun çoklu seviyeli tıkanıklıkları tespit edebilir mi?

Abstract

Amaç: Müller manevrası MM ’nın obstrüktif uyku apne sendromu OUAS ’nun şiddeti ve üst hava yolundaki tıkanıklık seviyesinin tespitindeki rolü ortaya kondu.Hastalar ve Yöntemler: Ankara Onkoloji Eğitim ve Araştırma Hastanesi, Kulak Burun Boğaz, uyku ve horlama polikliniğinde, OUAS şüphesiyle başvuran MM’de dahil olmak üzere rutin kulak burun boğaz muayenelerini takiben polisomnografi yapıldı. Çalışmaya 221 OUAS’li hasta 142 erkek, 179 kadın; ort. yaş; 46.63 yıl; dağılım 17-82 yıl dahil edildi.Bulgular: Apne hipopne indeksi AHİ sonuçları ile vücut kitle indeksi VKİ , tonsil büyüklüğü ve MM’de tespit edilen tıkanıklık şiddeti arasında anlamlı fark bulunamadı p>0.05 . Müller manevrası sonuçları ile Epworth uykululuk skalası EPUS arasında anlamlı fark tespit edildi r=0.213 ve p

Keywords

Müller manevrası, obstrüktif uyku apne sendromu, uvulopalatofarengoplasti, videoendoskopi

References

• Schwab RJ. Upper airway imaging. Clin Chest Med 1998;19:33-54.
• Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med 2002;347:498-504.
• Terris DJ, Hanasono MM, Liu YC. Reliability of the Muller maneuver and its association with sleep-disor- dered breathing. Laryngoscope 2000;110:1819-23.
• Borowiecki BD, Sassin JF. Surgical treatment of sleep apnea. Arch Otolaryngol 1983;109:508-12.
• Johns MW. Daytime sleepiness, snoring, and obstruc- tive sleep apnea. The Epworth Sleepiness Scale. Chest 1993;103:30-6.
• Schwab RJ, Goldberg AN. Upper airway assess- ment: radiographic and other imaging techniques. Otolaryngol Clin North Am 1998;31:931-68.
• 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.
• Stanford W, Galvin J, Rooholamini M. Effects of awake tidal breathing, swallowing, nasal breathing, oral breathing and the Müller and Valsalva maneuvers on the dimensions of the upper airway. Evaluation by ultra- fast computerized tomography. Chest 1988;94:149-54.
• Thong JF, Pang KP. Clinical parameters in obstructive sleep apnea: are there any correlations? J Otolaryngol Head Neck Surg 2008;37:894-900.
• McNicholas WT. Obstructive sleep apnea and inflam- mation. Prog Cardiovasc Dis 2009;51:392-9.
• Friberg D. Heavy snorer’s disease: a progressive local neuropathy. Acta Otolaryngol 1999;119:925-33.
• Shepard JW Jr, Gefter WB, Guilleminault C, Hoffman EA, Hoffstein V, Hudgel DW, et al. Evaluation of the upper airway in patients with obstructive sleep apnea. Sleep 1991;14:361-71.
• Yagi H, Nakata S, Tsuge H, Yasuma F, Noda A, Morinaga M, et al. Morphological examination of upper airway in obstructive sleep apnea. Auris Nasus Larynx 2009;36:444-9.
• Hsu PP, Tan BY, Chan YH, Tay HN, Lu PK, Blair RL. Clinical predictors in obstructive sleep apnea patients with computer-assisted quantitative videoendoscopic upper airway analysis. Laryngoscope 2004;114:791-9.
• Katsantonis GP, Maas CS, Walsh JK. The predictive efficacy of the Müller maneuver in uvulopalatophar- yngoplasty. Laryngoscope 1989;99:677-80.
• 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.
• Gerek M, Akçam T, Durmaz A. Radiofrequency ther- mal ablation of the soft palate in patients with snor- ing and mild sleep apnea. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2005;14:67-78.
• Dündar A, Gerek M, Ozünlü A, Yetiser S. Patient selec- tion and surgical results in obstructive sleep apnea. Eur Arch Otorhinolaryngol 1997;254 Suppl 1:S157-61.