Abstract
Objective: To determine if awake clinical evaluation methods like Friedman’s Tongue Position (FTP), endoscopic assessment of the hypopharynx using Mueller maneuver (MM), and during end expiration (EEPBOT) to assess tongue-base obstruction correlate well with tongue-base obstruction seen during drug-induced sleep endoscopy (DISE).
Method: Pilot prospective study of 16 patients with moderate to severe OSA recruited over 1 year at a tertiary care center. These patients were evaluated in the clinic with the flexible nasendoscope and subsequently underwent full PSG and DISE with midazolam.
Results: The 16 patients studied had a mean AHI of 65 (range, 18.8 to 129). Fifteen out of 16 patients (93.7%) were found to have multi segment obstruction on DISE according to the original grading proposed by Pringle and Croft. Comparing the various awake dynamic maneuvers against DISE as a gold standard, MM was found to have sensitivity of 53%, FTP had a sensitivity of 80%, and EEPBOT had a sensitivity of 93%. Because of the skewed nature of the results (only 1 out of 16 patients [6.3%] was classified as not having obstruction), specificity results had no statistical value.
Conclusion: This small pilot study showed a good correlation between EEPBOT, FTP, and DISE. A poorer correlation between MM and DISE is seen. Our results suggest that EEPBOT and FPP are superior to MM in evaluating tongue-base obstruction in OSA; however, further research is required to support these findings.
Get full access to this article
View all access options for this article.