title: The prognostic value of simulated snoring in awake patients with suspected sleep-disordered breathing: introduction of a new technique of examination.
abstract: OBJECTIVE
  A clinical examination of the upper airway in patients with suspected sleep-disordered breathing (SDB) is frequently performed before nighttime polysomnography. In recent years, the findings of "static" examinations, such as dorsalization of the tongue base, the Malampatti index, and Mueller maneuver, have been determined to be of low predictive value.
  
  
  METHODS
  We developed a new method of "dynamic" examination of the upper airway during simulated snoring in awake patients and analyzed the method in terms of the predictive value for suspected SDB.
  
  
  METHODS
  N/A PATIENTS: One hundred thirty-one patients were examined prior to night-time polysomnography, and the results were correlated with the apneahypopnea-index (AHI).
  
  
  METHODS
  N/A RESULTS: A significant correlation was detected between an increased dorsal movement of the tongue base, as well as with pharyngeal collapse at the level of the tongue base and the AHI. Pharyngeal collapse at the level of the velum did not correlate with the AHI. The patient's body position during simulated snoring did not influence the results. The "static" examinations, such as the dorsalization of the tongue base, tonsil size, Malampatti index, and Mueller maneuver, did not correlate with the AHI. Patients with a high degree of pharyngeal collapse at the level of the tongue base, in combination with dorsal movement of the tongue base during simulated snoring, revealed a probability of 75% to have an AHI more than 10 and of 92% for an AHI more than 5.
  
  
  CONCLUSIONS
  The "dynamic" examination of the upper airway under simulated snoring in awake patients is an easy-to-perform method to predict the probability of SDB prior to nighttime polysomnography.
authors.affiliation: Department of Otorhino-laryngology, Head and Neck Surgery, Ernst-Moritz-Arndt University, Walther-Rathenau-Str. 43-45, 17487 Greifswald, Germany. michael.herzog@uni-greifswald.de
authors.forename: Michael
authors.initials: M
authors.lastname: Herzog
authors.forename: Till
authors.initials: T
authors.lastname: Metz
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Bremert
authors.forename: Beatrice
authors.initials: B
authors.lastname: Venohr
authors.forename: Werner
authors.initials: W
authors.lastname: Hosemann
authors.forename: Holger
authors.initials: H
authors.lastname: Kaftan
mesh_terms: D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010160:Palate, Soft / Q000503:physiopathology*; D010614:Pharynx / Q000503:physiopathology; D010808:Physical Examination; D017286:Polysomnography; D011379:Prognosis; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D012913:Snoring / Q000503:physiopathology*; D014059:Tongue / Q000503:physiopathology; D014609:Uvula / Q000503:physiopathology*; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis* / Q000503:physiopathology; D014851:Wakefulness / Q000502:physiology*