title: Can the Müller maneuver detect multilevel obstruction of the upper airway in patients with obstructive sleep apnea syndrome?
abstract: OBJECTIVE
  Our aim is to figure out the role of Müller maneuver (MM) to detect the level of upper airway obstruction and the severity of obstructive sleep apnea syndrome (OSAS).
  
  
  METHODS
  In this study, polysomnographies were made after the routine otorhinolaryngological examination including MM in patients admitted with OSAS suspicion in Ankara Oncology Training and Research Hospital's Department of Otorhinolaryngology, Sleep Medicine Policlinic. Two-hundred and twenty-one OSAS patients (142 males, 179 females; mean age 47.63 years; range 18 to 82 years) were included to the study.
  
  
  RESULTS
  There weren't any significant correlation among apnea hypopnea index (AHI) results and body mass index (BMI), tonsil size and obstruction severity due to MM (p>0.05). Müller maneuver scores are positively correlated to the Epworth sleepiness scale (EPSS) scores (r=0.213 and p<0.001). Epworth sleepiness scale scores are found to be correlated to BMI and neck circumference (p<0.05). Level of the airway obstruction doesn't affects the EPSS scores (p=0.235). Also EPSS scores are not affected from uni or multilevel obstruction (p=0.088).
  
  
  CONCLUSIONS
  The severity of the MM score is not correlated to the severity of OSAS according to AHI results, but it is found to be correlated to EPSS. Vibrating tissues caused local and systemic inflammation in OSAS patients. The correlation between EPSS and MM scores can be explained by this inflammatory process. Further prospective studies have to be done in this field. Müller maneuver in an awake patient might reflect the levels of the obstruction in sleep conditions even though insufficient for figuring out the severity of OSAS.
authors.affiliation: Department of Otolaryngology, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Umit
authors.initials: U
authors.lastname: Tunçel
authors.forename: Hasan Mete
authors.initials: HM
authors.lastname: Inançli
authors.forename: Sefik Sinan
authors.initials: SS
authors.lastname: Kürkçüoğlu
authors.forename: Murat
authors.initials: M
authors.lastname: Enöz
mesh_terms: D003937:Diagnosis, Differential; D004569:Electroencephalography; D004585:Electrooculography; D005260:Female; D006801:Humans; D008297:Male; D009305:Nasopharynx / Q000503:physiopathology; D017286:Polysomnography / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology