Abstract
Objective: 1) Assess the association between tongue position and risk of obstructive sleep apnea (OSA) as measured by both Mallampati (MP -including classic 3-level and modified 4-level scoring with tongue protrusion) and Friedman Tongue Position (FTP-no tongue protrusion). 2) Determine which of these assessment scales best predicts OSA risk.
Method: PubMed, MEDLINE, Cochrane Trial Registry (through 12/2011), and relevant article bibliographies were searched. All studies were assessed by 3 reviewers. Systematic review and random-effects meta-analysis of studies assessing the association of tongue position and risk of OSA were performed. Outcomes are reported as odds ratios (OR).
Results: Combined data from 5 studies (46,264 patients) revealed an overall OR of 2.436 (1.828, 3.248; P < .001) for presence of OSA with MP/FTP 3 or 4 compared with MP/FTP 1 or 2. Sensitivity analysis revealed OR of 2.185 (1.643, 2.905; P < .001) for MP 3/4 and 4.408 (2.651, 7.327; P < .001) for FTP 3/4, respectively. Combined data from 2 studies (240 patients) revealed an OR for OSA per 1-point increase in MP/FTP of 2.351 (1.430, 3.865; P < .001). Sensitivity analysis revealed OR of 2.5 (1.225, 5.103; P = .012) and 2.219 (1.109, 4.437; P = .024) per 1-point increase in MP and FTP, respectively.
Conclusion: Tongue position 3 or 4, whether classified by MP or FTP, is significantly associated with increased OSA risk. In the clinical assessment of patients with suspected OSA, FTP 3/4 appears to have a higher predictive value for OSA than classic MP 3 or modified MP 3/4.
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