low at 150 Pa (P = .02), and age (P = .007) were related to OSAS severity. Curiously, AHI in patients who had undergone tonsillectomy was higher than in the TS1 group (tonsils inside the tonsillar fossa) and quite similar to the TS 2 group (tonsils that extend beyond the tonsillar pillars). In the multiple regression model, only the FTP score showed a relevant relationship to OSAS severity.
Conclusions First, since the FTP score is almost the only parameter related to OSAS severity, a simple oropharyngeal examination can provide key information on this issue. Second, tonsillectomy does not seem to protect against development of OSAS.
Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disease in the general population. In 1993, Young et al1 estimated a prevalence of sleep-disordered breathing of 9% for women and 24% for men in the 30- to 60-year-old group. In Spain, Durán et al2 observed that 19% of men and 15% of women ages 30 to 70 years had an apnea-hypopnea index (AHI) of 10.0/hour or higher. More recently, the prevalence of OSAS has been estimated to range from 3% to 7% in men and from 2% to 5% in women3
Although the pathogenesis of the disease has not been definitively established, it is currently accepted that the disease is caused by partial or complete obstruction of the upper airway, with involvement of the oropharynx at 1 or more levels.4,5 In 98% of patients with OSAS, the condition is due to abnormal anatomical features of the soft tissues and/or the structures of the maxillomandibular skeleton that cause a “disproportionate anatomy” of the airway,4,5 and in only 2% of adult patients is the condition due to a space-occupying lesion, such as a tonsillar or uvula hypertrophy, in which case resection would be curative.
In spite of recent medical advances, 70% to 80% of cases remain undiagnosed.6,7 To some extent, this is due to the fact that patients are not aware of the disease, but the logistic difficulties of diagnosis should also be borne in mind. Finally, there is no simple, fast physical examination that facilitates screening of patients possibly affected by the disease or prediction of its severity.
The purpose of this study was to validate the clinical usefulness of easy-to-assess clinical signs such as the Friedman tongue position (FTP), uvula size, and certain complementary examinations whose importance has not been clearly established, and to explore their potential value as predictors of the AHI.
Patients who were naïve for sleep studies were referred to the sleep laboratory for diagnosis and treatment of OSAS. Clinical suspicion of OSAS was established on the basis of snoring and daytime sleepiness recorded during the clinical interview with the Spanish version of the Epworth Sleepiness Scale.8 Patients with snoring history and clinical suspicion of OSAS entered the study protocol.
For inclusion, an individual had to be an adult patient (>18 years) referred to our Institution to diagnose or rule out OSAS. Exclusion criteria included (1) having other respiratory diseases, (2) having undergone a tracheostomy, (3) having a clinical suspicion of other sleep disorders, (4) having other comorbidities (chronic renal, cardiac, or hepatic failure), (5) having active neoplasms, or (6) refusal to follow the study protocol of our sleep disorders unit.
We divided patients into 4 groups: group 1 comprised individuals without OSAS; group 2, patients with mild OSAS; group 3, patients with moderate OSAS; and group 4, patients with severe OSAS. We planned to have a minimum of 30 patients in the smallest FTP group. We considered that many of the patients referred to our sleep laboratory would present some degree of sleep apnea; only a minority were expected to be snorers without sleep disorder (<10%). We also estimated a loss to follow-up of 10%. In view of our past experience, we expected the frequency of sleep apnea to be 3 times higher in groups 2 and 3 than in groups 1 and 4; we therefore aimed to include a minimum of 268 patients.
This was a single-center, observational, cross-sectional study performed