title: Computer-assisted quantitative evaluation of obstructive sleep apnea using digitalized endoscopic imaging with Muller maneuver.
abstract: OBJECTIVE
  To validate the technique of the Muller maneuver (MM) using videoendoscopy and to quantify the correlation between its clinical results and variables of polysomnography.
  
  
  METHODS
  Prospective, controlled study.
  
  
  METHODS
  Videoendoscopy with MM was performed in 70 patients who were categorized into two groups, with 35 patients giving a history suggestive of snoring and 35 patients without such history. The snoring group underwent further examination with polysomnography. Cross-sectional areas at the retropalatal (RP) and retrolingual (RL) levels during quiet respiration (RP(0) or RL(0)) and the maximal effort of MM (RP(1) or RL(1)) were calculated with the digital measurement software "Image J." One hundred forty pairs of data were acquired. The collapsing ratio (CR) was defined as the difference of RP(0) (or RL(0)) between RP1 (or RL(1)) divided by RP(0) (or RL(0)) to compare the difference between the two phases. These results were compared with each other and correlated to the variables obtained from polysomnographic studies.
  
  
  RESULTS
  There were significant differences in the CR of RP (CR(RP)), the CR of RL (CR(RL)), and body mass index (BMI) when comparing the two groups. In snoring patients, BMI was positively related to the respiratory disturbance index (RDI) and obstructive sleep apnea (OSA) staging but not to CR(RP) and CR(RL). CR(RP) had a significant positive relationship with RDI and OSA rather than CR(RL).
  
  
  CONCLUSIONS
  MM with videoendoscopy can be a simple, cost-effective, quantitative, and even predictable technique. This method allows us to examine the dynamic upper airway for more precise preoperative planning.
authors.affiliation: Department of Otolaryngology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ming-Tse
authors.initials: MT
authors.lastname: Ko
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D003936:Diagnosis, Computer-Assisted; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000379:methods*; D017286:Polysomnography / Q000295:instrumentation; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis*; D012913:Snoring / Q000175:diagnosis / Q000209:etiology; D014743:Videotape Recording