Figure 1. The different Friedman tongue position scores (reproduced with permission5). A, Grade 1: the examination allows a complete view of the uvula, the soft palate and the tonsils; B, grade 2: the uvula is visible, but not the tonsils; C, grade 3: the soft palate can be seen, but not the uvula; D, grade 4: only the hard palate can be seen.
Figure 2. Tonsil size score according to Friedman's criteria (reproduced with permission5). A, Grade 0 (patients who have had their tonsils removed); B, grade 1 (when the tonsils are inside the tonsillar fossa); C, grade 2 (when they extend beyond the tonsillar pillars); D, grade 3 (when they extend beyond the tonsillar pillars but do not reach the midline); E, grade 4 (when they extend as far as the midline, almost touching each other).
Figure 3. Distribution of apnea-hypopnea index (AHI) (log scale) by Friedman tongue position (FTP) score. The bottom and top of the box are the 25th and 75th percentiles (the lower and upper quartiles, respectively), and the band near the middle of the box is the 50th percentile (the median). The ends of the whiskers represent the lowest datum still within 1.5 interquartile range (IQR) of the lower quartile, and the highest datum still within 1.5 IQR of the upper quartile. The circles indicate outliers.
Figure 4. Distribution of apnea-hypopnea index (AHI) (log scale) by tonsil size (TS) score. The bottom and top of the box are the 25th and 75th percentiles (the lower and upper quartiles, respectively), and the band near the middle of the box is the 50th percentile (the median). The ends of the whiskers represent the lowest datum still within 1.5 interquartile range (IQR) of the lower quartile, and the highest datum still within 1.5 IQR of the upper quartile. The circles indicate outliers.
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Barceló X, Mirapeix RM, Bugés J, Cobos A, Domingo C. Oropharyngeal Examination to Predict Sleep Apnea Severity. Arch Otolaryngol Head Neck Surg. 2011;137(10):990–996. 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 f