The Relationship Between Modified Mallampati Score, Müller’s Maneuver and Drug-Induced Sleep Endoscopy Regarding Retrolingual Obstruction

Wang, Weimin; Hsu, Yu‐Sheng; Lan, Ming‐Ying; Yang, Mei‐Chen; Huang, Tung-Tsun; Liu, Chia-Jung; Lan, Ming‐Chin

doi:10.1177/0003489418778302

Cited by 26 publications

(17 citation statements)

References 28 publications

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“…42 However, there was no statistically significant difference in this study, in which a complete tongue base collapse was identified in 30.6% of individuals with FTP grades III and IV, while Wang et al found an incidence of 32% in individuals with MMC classes III and IV. 42 In addition, we found no association between retroglossal collapse and tongue position on DISE, similar to the findings of den Herder et al 43 Tongue base collapse has a more complex pathogenesis, related not only to tongue position and/or volume but also to muscle tone during sleep. 44,45 There were some limitations to this study to consider.…”

Section: Discussioncontrasting

confidence: 72%

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Zhao

Viana

et al. 2020

NSS

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Identification of upper airway (UA) obstruction based on pharyngeal factors is important for obstructive sleep apnea (OSA) evaluation. This study is to assess the association between UA collapse characteristics and Friedman tongue position (FTP) in patients with OSA through drug-induced sleep endoscopy (DISE). Patients and Methods: Retrospective study in individuals with OSA who were intolerant to continuous positive airway pressure (CPAP) treatment, submitted to DISE between June 1, 2013, and July 31, 2017. All subjects were classified as having an FTP grade of I to IV, and the velum, oropharynx, tongue base, epiglottis (VOTE) classification was used to analyze the DISE findings. UA collapse characteristics by DISE and FTP grading were compared between groups. The associations between specific DISE findings and FTP were analyzed. Results: In total, 205 patients were assessed. A positive and significant correlation was identified between the presence of retropalatal complete concentric collapse (CCC) and FTP grade, according to the following distributions: I, 17.4%; II, 22.9%; III, 33.7%; and IV, 48.7% (P = 0.014). A logistic regression model revealed that CCC was associated with FTP grade IV. After adjusting for age, sex, body mass index (BMI), and tonsil size (TS), the grade IV individuals had a 4.4-fold higher risk of having CCC than grade I individuals (P = 0.026). Multiple collapse sites and palatopharyngeal or combined (palatopharyngeal and hypopharyngeal) collapse were more prevalent in grade IV individuals. Conclusion: OSA patients intolerant to CPAP have a strong positive correlation between the FTP grade and presence of retropalatal CCC. FTP grade IV is an independent risk factor for velum-CCC, controlling for sex, age, BMI, and TS grade.

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Section: Discussioncontrasting

confidence: 72%

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Zhao

Viana

et al. 2020

NSS

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“…Because MMS was used to score a large tongue size, and DISE was used to assess obstruction at tongue base level, both assessments were recorded differently. However, Wang et al showed a significant correlation between MMS and DISE in the evaluation of tongue base collapse [ 15 ]. The different view was that retrolingual obstruction occurred due to muscular hypotonia, resulting in upper airway collapse during sleep.…”

Section: Discussionmentioning

confidence: 99%

“…An Olympus 3.2 mm fibro-optic scope passed through the nose to survey velum, oropharynx, and tongue base; epiglottis was used for evaluation. Every patient received level dimensional change by inhaling with a blocked nose to cause negative pressure and the collapse percentage of the airway in the velum, oropharynx, and tongue base areas; the epiglottic area was assessed and graded under Wang’s grading system [ 15 ]. The collapsibility and dimensional change were recorded as follows: retropalatal anterior and posterior (A–P) collapse grade 0–2; retropalatal lateral collapse grade 0–2; retropalatal circumferential collapse grade 0–2; retroglossal A–P collapse grade 0–2; retoglossal lateral-to-lateral (L–L) collapse grade 0–2; and retroglossal circumferential collapse grade 0–2.…”

Section: Methodsmentioning

confidence: 99%

“…The collapsibility and dimensional change were recorded as follows: retropalatal anterior and posterior (A–P) collapse grade 0–2; retropalatal lateral collapse grade 0–2; retropalatal circumferential collapse grade 0–2; retroglossal A–P collapse grade 0–2; retoglossal lateral-to-lateral (L–L) collapse grade 0–2; and retroglossal circumferential collapse grade 0–2. Grade 0 indicated no observed airway obstruction, grade 1 indicated partial obstruction, and grade 2 indicated total obstruction [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

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Comparison of Findings between Clinical Examinations and Drug-Induced Sleep Endoscopy in Patients with Obstructive Sleep Apnea Syndrome

Lin

Hsu

et al. 2020

IJERPH

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The Velum, Oropharynx, Tongue base and Epiglottis (VOTE) classification on drug-induced sleep endoscopy (DISE) is used widely for obstructive sleep apnea (OSA) syndrome, though research into comparative physical examinations with VOTE on DISE is still limited. The aim of this study was to evaluate the relationship between the findings of physical examinations and DISE in patients with OSA. Fifty-five patients with OSA were enrolled in this retrospective study. All of the patients received clinical explorations including a Brodsky classification, a modified Mallampati score (MMS), a modified Friedman’s staging system, and a Muller’s test. Drug-induced sleep endoscopy was further evaluated in the operating room. There were significant relationships between Brodsky classification, modified Friedman’s staging system, Muller’s test and oropharynx collapse during DISE (p < 0.05). Brodsky classification, MMS, modified Friedman’s staging system and retropalatal lateral-to-lateral (L–L) collapse of Muller’s test were significantly correlated with VOTE count (p < 0.05). The concordance between VOTE under DISE and Brodsky classification or modified Friedman’s staging system was moderate. In contrast, the concordance between VOTE under DISE and MMS or Muller’s test was slight. The study revealed that Brodsky classification and Friedman staging had a significant relationship with DISE on the velum and oropharynx, but the level of tongue base is uncertain between DISE and MMS. Correlation of awake evaluation of tongue base is still not correlated to the DISE findings. Pre-treatment evaluation of DISE is still warranted.

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“…For example, it has been proposed that a simple anatomical assessment in the Mallampati Score may be a reflection of anatomical balance [ 99 ] and this has been explored as a simple anatomical phenotype of OA m response. Mallampati score may also be an indicator of the site of pharyngeal collapse, particularly retrolingual collapse [ 100 ]. A simplified method of quantitative assessment of facial phenotype from photographs has been developed in OSA patients which reflects OSA risk [ 101 – 103 ].…”

Section: Personalisation Strategies and Toolsmentioning

confidence: 99%

From CPAP to tailored therapy for obstructive sleep Apnoea

Sutherland

Kairaitis

Yee

et al. 2018

Multidiscip Respir Med

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Obstructive Sleep Apnoea (OSA) is a common sleep disorder that is associated with daytime symptoms and a range of comorbidity and mortality. Continuous Positive Airway Pressure (CPAP) therapy is highly efficacious at preventing OSA when in use and has long been the standard treatment for newly diagnosed patients. However, CPAP therapy has well recognised limitations in real world effectiveness due to issues with patient acceptance and suboptimal usage. There is a clear need to enhance OSA treatment strategies and options. Although there are a range of alternative treatments (e.g. weight loss, oral appliances, positional devices, surgery, and emerging therapies such as sedatives and oxygen), generally there are individual differences in efficacy and often OSA will not be completely eliminated. There is increasing recognition that OSA is a heterogeneous disorder in terms of risk factors, clinical presentation, pathophysiology and comorbidity. Better characterisation of OSA heterogeneity will enable tailored approaches to therapy to ensure treatment effectiveness. Tools to elucidate individual anatomical and pathophysiological phenotypes in clinical practice are receiving attention. Additionally, recognising patient preferences, treatment enhancement strategies and broader assessment of treatment effectiveness are part of tailoring therapy at the individual level. This review provides a narrative of current treatment approaches and limitations and the future potential for individual tailoring to enhance treatment effectiveness.

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The Relationship Between Modified Mallampati Score, Müller’s Maneuver and Drug-Induced Sleep Endoscopy Regarding Retrolingual Obstruction

Cited by 26 publications

References 28 publications

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Comparison of Findings between Clinical Examinations and Drug-Induced Sleep Endoscopy in Patients with Obstructive Sleep Apnea Syndrome

From CPAP to tailored therapy for obstructive sleep Apnoea

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