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

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/m 2 (range 21.9 to 48.4 kg/m 2 ) 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.Keywords: Müller maneuver; obesity; obstructive sleep apnea. ) 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 Sözcükler: Müller manevrası; obezite; obstrüktif uyku apnesi.

Mallampatti Score as a Predictor for Risk of Obstructive Sleep Apnea

“…For the identification of high risk patients, likely to develop obstructive sleep apnea, Epworth and Berlin questionnaires have been developed. During general physical examination, high Mallampatti Score was seen in patients presenting with obstructive sleep apnea 10,15 .…”

“…Obesity and old age are increasing now a days due to which obstructive sleep apnea incidence is on the rise 10 . In USA, there has been observed a rise in obesity and high body mass index, even in children 7 .…”