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

Year 2017, Volume: 27 Issue: 2, 65 - 73, 18.06.2017

Abstract

Objectives: This study aims to evaluate anatomic abnormalities that may be associated with obesity and may cause sleep apnea in patients with obstructive sleep apnea-hypopnea syndrome OSAHS by physical examination and Müller maneuver. Patients and Methods: This single center, prospective, cross-sectional study included 330 OSAHS patients 274 males, 56 females; mean age 47±11 years; range 17 to 79 years who were performed polysomnography. Patients’ clinical history as well as otolaryngology examination findings including pharyngeal soft tissues, anterior rhinoscopy and Müller maneuver were recorded. Results: Mean body mass index BMI was 32±5 kg/m2 range 21.9 to 48.4 kg/m2 and apnea-hypopnea index AHI was 27±24 episodes per hour range 0 to 106 episodes/hour . The AHI and BMI were statistically significantly correlated with minimum oxygen saturation, neck circumference, waist circumference, Epworth Sleepiness Scale score, retropalatal and retroglossal grades, tonsil size, and modified Mallampati score. Patients with higher AHI or BMI had statistically significantly higher retropalatal, retroglossal, and combined retropalatal and retroglossal grades p≤0.001 . Conclusion: Obesity affects the retropalatal and retroglossal grades and modified Mallampati scores of patients with OSAHS. High scores of those variables with low BMI may be attributed to upper airway soft tissue or craniofacial bony abnormalities. The retropalatal airway may narrow earlier than the retroglossal airway when fat accumulation starts in the lateral pharyngeal walls and tongue.

References

  • 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.
  • Kyzer S, Charuzi I. Obstructive sleep apnea in the obese. World J Surg 1998;22:998-1001.
  • Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J 1999;13:403-10.
  • Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology 2012;17:32-42.
  • Sutherland K, Lee RW, Phillips CL, Dungan G, Yee BJ, Magnussen JS, et al. Effect of weight loss on upper airway size and facial fat in men with obstructive sleep apnoea. Thorax 2011;66:797-803.
  • Scottish Intercollegiate Guidelines Network. Management of Obstructive Sleep Apnoea/Hypopnoea Syndrome in Adults. A National Clinical Guideline. Edinburgh: Royal College of Physicians; 2003. p. 4.
  • Woodson BT. Predicting which patients will benefit from surgery for obstructive sleep apnea: the ENT exam. Ear Nose Throat J 1999;78:792-5.
  • Zonato AI, Bittencourt LR, Martinho FL, Jşnior JF, Gregório LC, Tufik S. Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome. Laryngoscope 2003;113:973-80.
  • Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003;168:522-30.
  • Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-76.
  • Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 2010;33:1408-13.
  • Dreher A, de la Chaux R, Klemens C, Werner R, Baker F, Barthlen G, et al. Correlation between otorhinolaryngologic evaluation and severity of obstructive sleep apnea syndrome in snorers. Arch Otolaryngol Head Neck Surg 2005;131:95-8.
  • Barceló X, Mirapeix RM, Bugés J, Cobos A, Domingo C. Oropharyngeal examination to predict sleep apnea severity. Arch Otolaryngol Head Neck Surg 2011;137:990-6.
  • Andreoli TE. Cecil RL. Cecil Essentials of Medicine. 2nd ed. Vol. XIV. Philadelphia: Saunders, 1990:830.
  • Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89.
  • Vicini C, De Vito A, Benazzo M, Frassineti S, Campanini A, Frasconi P, et al. The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol 2012;269:1297-300.
  • Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 1999;109:1901-7.
  • Terris DJ, Hanasono MM, Liu YC. Reliability of the Muller maneuver and its association with sleep- disordered breathing. Laryngoscope 2000;110:1819-23. Isono 19.
  • Watanabe T, S, Tanaka A, Tanzawa H, Nishino T. Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing. Am J Respir Crit Care Med 2002;165:260-5.

Obstrüktif uyku apne-hipopne sendromunda obezitenin üst solunum yolu fizik muayenesine etkisi

Year 2017, Volume: 27 Issue: 2, 65 - 73, 18.06.2017

Abstract

Amaç: Bu çalışmada obstrüktif uyku apne-hipopne sendromu OUAHS olan hastalarda obeziteyle ilişkili olup uyku apnesine neden olabilecek anatomik anormallikler fizik muayene ve Müller manevrası ile değerlendirildi.Hastalar ve Yöntemler: Bu tek merkezli, prospektif, kesitsel çalışmaya polisomnografi uygulanan 330 OUAHS hastası 274 erkek, 56 kadın; ort. yaş 47±11 yıl; dağılım 17-79 yıl dahil edildi. Hastaların klinik öyküsü ile birlikte farengeal yumuşak dokuları, anterior rinoskopiyi ve Müller manevrasını içeren otolarengoloji muayenesi bulguları kaydedildi.Bulgular: Ortalama vücut kütle indeksi VKİ 32±5 kg/m2 dağılım 21.9-48.4 kg/m2 ve apne-hipopne indeksi saatte 27±24 epizod dağılım 0-106 epizod/saat idi. Apne-hipopne indeksi ve VKİ; minimum oksijen satürasyonu, boyun çevresi, karın çevresi, Epworth Uykululuk Skalası skoru, retropalatal ve retroglossal evre, tonsil büyüklüğü ve modifiye Mallampati skoru ile istatistiksel olarak anlamlı şekilde ilişkiliydi. Apne-hipopne indeksi veya VKİ’si daha yüksek olan hastalar istatistiksel olarak daha yüksek retropalatal, retroglossal ve kombine retropalatal ve retroglossal evreye sahipti p≤0.001 .Sonuç: Obezite, OUAHS’li hastaların retropalatal ve retroglossal evrelerini ve modifiye Malampati skorlarını etkiler. Bu değişkenlere ait skorların yüksek, VKİ’nin düşük olması, üst solunum yolu yumuşak doku veya kraniyofasiyal kemik anormalliklerine bağlanabilir. Lateral farengeal duvarlarda ve dilde yağ birikimi başladığında retropalatal hava yolu, retroglossal hava yolundan önce daralabilir

References

  • 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.
  • Kyzer S, Charuzi I. Obstructive sleep apnea in the obese. World J Surg 1998;22:998-1001.
  • Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J 1999;13:403-10.
  • Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology 2012;17:32-42.
  • Sutherland K, Lee RW, Phillips CL, Dungan G, Yee BJ, Magnussen JS, et al. Effect of weight loss on upper airway size and facial fat in men with obstructive sleep apnoea. Thorax 2011;66:797-803.
  • Scottish Intercollegiate Guidelines Network. Management of Obstructive Sleep Apnoea/Hypopnoea Syndrome in Adults. A National Clinical Guideline. Edinburgh: Royal College of Physicians; 2003. p. 4.
  • Woodson BT. Predicting which patients will benefit from surgery for obstructive sleep apnea: the ENT exam. Ear Nose Throat J 1999;78:792-5.
  • Zonato AI, Bittencourt LR, Martinho FL, Jşnior JF, Gregório LC, Tufik S. Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome. Laryngoscope 2003;113:973-80.
  • Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003;168:522-30.
  • Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-76.
  • Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 2010;33:1408-13.
  • Dreher A, de la Chaux R, Klemens C, Werner R, Baker F, Barthlen G, et al. Correlation between otorhinolaryngologic evaluation and severity of obstructive sleep apnea syndrome in snorers. Arch Otolaryngol Head Neck Surg 2005;131:95-8.
  • Barceló X, Mirapeix RM, Bugés J, Cobos A, Domingo C. Oropharyngeal examination to predict sleep apnea severity. Arch Otolaryngol Head Neck Surg 2011;137:990-6.
  • Andreoli TE. Cecil RL. Cecil Essentials of Medicine. 2nd ed. Vol. XIV. Philadelphia: Saunders, 1990:830.
  • Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89.
  • Vicini C, De Vito A, Benazzo M, Frassineti S, Campanini A, Frasconi P, et al. The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol 2012;269:1297-300.
  • Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 1999;109:1901-7.
  • Terris DJ, Hanasono MM, Liu YC. Reliability of the Muller maneuver and its association with sleep- disordered breathing. Laryngoscope 2000;110:1819-23. Isono 19.
  • Watanabe T, S, Tanaka A, Tanzawa H, Nishino T. Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing. Am J Respir Crit Care Med 2002;165:260-5.
There are 19 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Suat Avcı This is me

Hüseyin Lakadamyalı This is me

Fuat Büyüklü This is me

Leyla Kansu This is me

Publication Date June 18, 2017
Published in Issue Year 2017 Volume: 27 Issue: 2

Cite

APA Avcı, S., Lakadamyalı, H., Büyüklü, F., Kansu, L. (2017). Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome. The Turkish Journal of Ear Nose and Throat, 27(2), 65-73.
AMA Avcı S, Lakadamyalı H, Büyüklü F, Kansu L. Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome. Tr-ENT. June 2017;27(2):65-73.
Chicago Avcı, Suat, Hüseyin Lakadamyalı, Fuat Büyüklü, and Leyla Kansu. “Effect of Obesity on Upper Airway Physical Examination in Obstructive Sleep Apnea-Hypopnea Syndrome”. The Turkish Journal of Ear Nose and Throat 27, no. 2 (June 2017): 65-73.
EndNote Avcı S, Lakadamyalı H, Büyüklü F, Kansu L (June 1, 2017) Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome. The Turkish Journal of Ear Nose and Throat 27 2 65–73.
IEEE S. Avcı, H. Lakadamyalı, F. Büyüklü, and L. Kansu, “Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome”, Tr-ENT, vol. 27, no. 2, pp. 65–73, 2017.
ISNAD Avcı, Suat et al. “Effect of Obesity on Upper Airway Physical Examination in Obstructive Sleep Apnea-Hypopnea Syndrome”. The Turkish Journal of Ear Nose and Throat 27/2 (June 2017), 65-73.
JAMA Avcı S, Lakadamyalı H, Büyüklü F, Kansu L. Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome. Tr-ENT. 2017;27:65–73.
MLA Avcı, Suat et al. “Effect of Obesity on Upper Airway Physical Examination in Obstructive Sleep Apnea-Hypopnea Syndrome”. The Turkish Journal of Ear Nose and Throat, vol. 27, no. 2, 2017, pp. 65-73.
Vancouver Avcı S, Lakadamyalı H, Büyüklü F, Kansu L. Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome. Tr-ENT. 2017;27(2):65-73.