Evaluation of airway obstruction by nasopharyngoscopy: comparison of the Müller maneuver versus induced sleep.
The use of nasopharyngoscopy during the application of intrathoracic pressure (Müller maneuver) is frequently employed to establish the site of upper airway obstruction. The Müller maneuver, however, is used when the patient is awake and therefore may not correlate with obstruction occurring during sleep.


OBJECTIVE
To compare the degree of pharyngeal obstruction in the retropalatal and retroglossal regions during the Müller maneuver versus induced sleep using nasopharyngoscopy.


METHODS
A prospective, case series study.


METHODS
Eight patients (three males, five females), with a mean age of 48.6 +/- 9.2 year, underwent nasopharyngoscopy to assess airway anatomy and function during the Müller maneuver while awake and during sleep induced by drip infusion of Midazolam.


RESULTS
Retropalatal obstruction was similar during the Müller maneuver and sleep (mean + standard deviation = 3.13 +/- 0.99 and 2.75 +/- 0.46, p= 0.234). Retroglossal obstruction was significantly lower during Müller maneuver compared to sleep (mean + standard deviation 0.63 +/- 1.06 and 2.63 +/- 1.30, respectively, p= 0.005).


CONCLUSIONS
The sleep inducing method was safe under the monitored conditions of this study, and detected more retroglossal obstruction than the Müller maneuver.
Gregório
Marcelo Gervilla
MG
Respiratory Endoscopy Service, University of São Paulo Medical School.
Jacomelli
Márcia
M
Figueiredo
Adelaide C
AC
Cahali
Michel Burihan
MB
Pedreira
Wilson Leite
WL
Lorenzi Filho
Geraldo
G
D000402:Airway Obstruction / Q000175:diagnosis* / Q000473:pathology; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012129:Respiratory Function Tests / Q000379:methods; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000473:pathology