The Relation of the Obstruction Site on Muller’s Maneuver with BMI, Neck Circumference and PSG Findings in OSAS

Abstract

We investigated relation of the site of obstruction detected on Muller maneuver (MM) with polysomnography (PSG) and physical examination findings. Data of 703 patients admitted to Ankara Numune Education and Research Hospital Sleep Laboratory between 2008 and 2013 were analyzed retrospectively; 394 patients with apnea-hypopnea indexes (AHI) ≥5/h were included. Site of collapse on MM was determined at retrolingual level at anteroposterior (M1) and lateral-lateral (M2) directions; at retropalatal level at anteroposterior (M3) and lateral-lateral (M4) directions. There were 125 (31.7 %) females and 269 (68.3 %) males. BMI had significant positive correlations with M2 (p < 0.001) and M4 (p = 0.002) scores, ESS (p = 0.013) and AHI (p = 0.001). AHI had significant positive correlations with ESS (p = 0.003), M2 (p < 0.001), M3 (p = 0.037) and M4 (p < 0.001) scores and NC (p = 0.001). Minimum oxygen saturation had significant reverse correlations with M1 (p = 0.046), M2 (p < 0.001), M3 (p = 0.003), M4 (p < 0.001), AHI (p < 0.001), ESS (p = 0.003) and BMI (p = 0.001). In OSAS patients, increased BMI, NC and AHI are correlated with lateral pharyngeal wall (LPW) collapse in retropalatal and retrolingual levels on MM. LPW collapse is more valuable to predict OSAS compared to anteroposterior collapse. LPW collapse on MM may be used as a selection criterion for ordering PSG. Further studies are needed to better clarify importance of LPW in OSAS surgery.

A new suggestion for the Epworth Sleepiness Scale in obstructive sleep apnea

“…Most authors were able to show a significant correlation of the ESS with AHI in OSAS patients [4,9,[12][13][14]. In our recent study, there was a significant correlation between the ESS and AHI [15]. However, some other authors could not find such a correlation [16].…”

What can anthropometric measurements tell us about obstructive sleep apnoea?

“…It is thought that high value of this parameter demonstrates the size of pharynx entrance and so it makes the air stream easier. Statistical analysis showed that there is a significant difference between the two groups [3,16,24].…”

“…Muller's manoeuvre has been the most investigated research subject till now. Different length and angular values were examined for the analyses of pharyngeal structure in radiographic studies [3,8,16,24,25]. It is believed in this study that bigonial width is one of the important parameters which determine pharyngeal entrance of human.…”

Drug‐induced sleep endoscopy versus Müller maneuver in patients with retropalatal obstruction

“…There are many studies in the literature that support the reliability of the MM or DISE, that contain overlapping findings, or that describe very different results. Some studies even report that one method has supremacy over the other in the detection of variable localization . The best supportive parameter of accuracy of preoperative diagnostic methods is the postoperative success rate.…”

“…Some studies even report that one method has supremacy over the other in the detection of variable localization. 6,23,24 The best supportive parameter of accuracy of preoperative diagnostic methods is the postoperative success rate. Whereas Sher et al claimed that the postoperative success rate increases with MM, somnofluoroscopy, and cephalometry, 25 and Camilleri et al claimed superiority with sleep endoscopy, 26 Hewitt et al could not detect a correlation between DISE and MM due to the inability to perform MM correctly.…”