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

Yıl 2017, Cilt: 27 Sayı: 2, 65 - 73, 18.06.2017

Suat Avcı Hüseyin Lakadamyalı Fuat Büyüklü Leyla Kansu

Öz

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.

Anahtar Kelimeler

Müller maneuver, obesity, obstructive sleep apnea

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

Öz

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

Anahtar Kelimeler

Müller manevrası, obezite, obstrüktif uyku apnesi

Kaynakça

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