title: Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome.
abstract: OBJECTIVE
  To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea-hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea-hypopnea index (AHI).
  
  
  METHODS
  Consecutive patients with obstructive sleep apnea-hypopnea syndrome who were evaluated in a public otorhinolaryngology center were studied.
  
  
  METHODS
  Adult patients evaluated previously with polysomnography met the inclusion criteria. All subjects underwent clinical history and otolaryngological examination and filled out a sleepiness scale. Physical examination included evaluation of pharyngeal soft tissue, facial skeletal development, and anterior rhinoscopy.
  
  
  RESULTS
  Two hundred twenty-three patients (142 men and 81 women) were included (mean age, 48 +/- 12 y; body mass index, 29 +/- 5 kg/m2; AHI, 23.8 +/- 24.8 events per hour). Patients were distributed into two groups according to the AHI: snorers (18.4%) and patients with sleep apnea (81.7%). Sleepiness and nasal obstruction were reported by approximately half of patients, but the most common complaint was snoring. There was a statistically significant correlation between AHI and body mass index (P <.000), modified Mallampati classification (P =.002), and ogivale-palate (P <.001). The retrognathia was not correlated to AHI, but the presence of this anatomical alteration was much more frequent in patients with severe apnea when compared with the snorers (P =.05). Other correlations with AHI were performed considering multiple factors divided into two groups of anatomical abnormalities: pharyngeal (three or more) and craniofacial (two or more) abnormalities. There was a statistically significant correlation between pharyngeal landmarks and AHI (correlation coefficient [r] = 0.147, P =.027), but not between craniofacial landmarks and AHI. The combination of pharyngeal anatomical abnormalities, modified Mallampati classification, and body mass index were also predictive of apnea severity.
  
  
  CONCLUSIONS
  Systematic physical examination that was used in the present study indicated that, in combination, body mass index, modified Mallampati classification, and pharyngeal anatomical abnormalities are related to both presence and severity of obstructive sleep apnea-hypopnea syndrome. Hypertrophied tonsils were observed in only a small portion of the patients. The frequency of symptoms of nasal obstruction was high in sleep apnea patients. Further studies are needed to find the best combination of anatomical and other clinical landmarks that are related to obstructive sleep apnea.
authors.affiliation: Sleep Center of the Department of Psychobiology, Universidade Federal de São Paulo, Brazil. aizonato@terra.com.br
authors.forename: Adriane I
authors.initials: AI
authors.lastname: Zonato
authors.forename: Lia Rita
authors.initials: LR
authors.lastname: Bittencourt
authors.forename: Fernanda Louise
authors.initials: FL
authors.lastname: Martinho
authors.forename: João Ferreira Santos
authors.initials: JF
authors.lastname: Júnior
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Gregório
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002508:Cephalometry; D019465:Craniofacial Abnormalities / Q000145:classification / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000145:classification / Q000175:diagnosis / Q000209:etiology; D010038:Otorhinolaryngologic Diseases / Q000175:diagnosis*; D010348:Patient Care Team; D010808:Physical Examination; D017286:Polysomnography; D063173:Retrognathia / Q000145:classification / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D012913:Snoring / Q000145:classification / Q000209:etiology