title: Transverse Retropalatal Collapsibility Is Associated with Obstructive Sleep Apnea Severity and Outcome of Relocation Pharyngoplasty.
abstract: OBJECTIVE
  The aim of this study was to investigate whether the retropalatal airway shape and collapsibility defined by awake nasopharyngoscopy with Müller's maneuver were associated with apnea-hypopnea index (AHI), positional dependency, and surgical outcome of relocation pharyngoplasty in patients with obstructive sleep apnea.
  
  
  METHODS
  Case series with planned data collection.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A total of 45 obstructive sleep apnea patients were included who underwent conservative treatment (n = 13) or relocation pharyngoplasty (n = 32), and their baseline and postoperative polysomnographies and awake nasopharyngoscopies with Müller's maneuver were reviewed. Shape ratio (transverse diameter [TD] / longitudinal diameter [LD]) in the stationary and Müller's phases and collapsibility (ColTD and ColLD) of the airway at the level of the uvular base were measured with a picture archiving and communication system. Intra- and interrater reliabilities were assessed. Associations among nasopharyngoscopic measurements, AHI, positional dependency, and surgical success (defined as a reduction of AHI ≥50% and a postoperative AHI ≤20/h) were statistically analyzed.
  
  
  RESULTS
  Reliability tests indicated substantial agreements of all nasopharyngoscopic measurements between raters and within raters. A higher baseline ColTD was significantly associated with an elevated AHI (r = 0.49, P = .001), whereas a lower postoperative ColTD was significantly related to surgical success (r = -0.38, P = .034). Nasopharyngoscopic findings were not statistically significantly correlated with positional dependency.
  
  
  CONCLUSIONS
  Transverse retropalatal collapsibility measured by awake nasopharyngoscopy with Müller's maneuver helps to predict individuals with moderate to severe sleep apnea and surgical outcome.
authors.affiliation: Department of Otolaryngology, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Hung-Chin
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan Department of Otolaryngology, Xiamen Chang Gung Hospital, Fujian Province, China.
authors.forename: Li-Ang
authors.initials: LA
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Hsin
authors.affiliation: Department of Otolaryngology, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Wan-Ni
authors.initials: WN
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan Department of Otolaryngology, Xiamen Chang Gung Hospital, Fujian Province, China.
authors.forename: Tuan-Jen
authors.initials: TJ
authors.lastname: Fang
authors.affiliation: Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chung-Guei
authors.initials: CG
authors.lastname: Huang
authors.affiliation: Department of Otolaryngology, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan hyli38@cgmh.org.tw.
authors.forename: Hsueh-Yu
authors.initials: HY
authors.lastname: Li
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000502:physiology; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D019651:Plastic Surgery Procedures; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Müller’s maneuver; apnea-hypopnea index; awake nasopharyngoscopy; collapsibility; obstructive sleep apnea; relocation pharyngoplasty; surgical outcome