6. doi:10.1001/archoto.2011.176
Author Affiliations: Otorhinolaryngology Service (Dr Barceló) and Pneumology Service (Dr Bugés), Hospital de l’Esperit Sant de Santa Coloma, Departments of Medicine (Dr Barceló and Domingo) and Morphological Sciences (Dr Mirapeix), Universitat Autònoma de Barcelona, Biostatistics Unit, Department of Public Health, Universitat de Barcelona (Dr Cobos), Saalig Clinical, SL (Dr Cobos), and Pneumology Service, Hospital Parc Taulí (Dr Domingo), Barcelona, Spain.
Objective To evaluate the usefulness of the examination of the upper airway, paying special attention to the Friedman tongue position (FTP), to confirm obstructive sleep apnea syndrome (OSAS) and its severity.
Design Prospective, single-center, cross-sectional study.
Setting Sleep disorders unit of a community hospital.
Patients A total of 301 consecutive patients admitted to the sleep disorders unit due to suspicion of OSAS. Assessments included body mass index calculated as weight in kilograms divided by height in meters squared (BMI); neck perimeter measurement; oropharyngeal examination; fiberendoscopy; rhinomanometry; and a sleep study.
Main Outcome Measures Apnea-hypopnoea index (AHI), FTP, the uvula size, and certain complementary examinations (sex, age, BMI, cervical perimeter, nasal flow) whose importance has not been clearly established, and to explore their potential value as predictors of the AHI.
Results Findings included the following: the mean (SD) age of the patients was 51 (12) years; 71.1% were male; the mean (SD) BMI was 29.8 (4.6); and the mean (SD) cervical perimeter, 40.5 (3.7) cm. In 94.0% of the patients the AHI value was at least 5.0/hour. Patients with FTP scores of 2 and 3 accounted for 74.1% of the whole cohort: 14.3% had an FTP score of 1, and only 11.6% had a score of 4. Of the 6.0% of cases with a normal AHI, 16 patients were classified as having FTP scores of 1, and 2 as having a score of 2. Tonsil size score (P = .005), uvula score (P = .003), BMI (P < .001), cervical perimeter (P < .001), nasal flow 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