Decision making for position-dependent obstructive sleep apnea syndrome on the basis of patient information and physical examinations of the upper airway, acquired on an outpatient basis

Abstract

Conclusions: Patients with body mass index (BMI) < 25 kg/m² and obstructive sleep apnea syndrome (OSAS) are highly suspicious for position-dependent OSAS. Diagnosis of position-dependent/position-independent OSAS can be difficult in patients satisfying both ‘BMI >25 kg/m²’ and ‘any of tongue enlargement (TE), palatine tonsil hypertrophy (PTH) and obstruction by Muller’s maneuver (OMM)’. Polysomnography is warranted in such patients.

Objectives: The objective was to retrospectively elucidate criteria for differentiating position-dependent OSAS on the basis of patient information and physical examinations of the upper airway obtainable in clinics.

Methods: The 643 patients were categorized as positional patients (PPs) or non-positional patients (NPPs). The patient background factors examined were sex, age, BMI, and hypertension. TE, PTH, pharyngeal tonsil hypertrophy, and OMM were evaluated. Cross-validation was performed using even-numbered registrations as the training set group (Group A) and odd-numbered registrations as the test case group (Group B).

Results: In Group A, patients with BMI <25 kg/m² were clearly more frequent among PP than among NPP. In Group A with BMI ≥25 kg/m², significant differences were found for TE, PTH and OMM. Significant differences were found between 0 and 1/2/3 for number of factors. Results generated from Group A were validated in Group B.

Chinese abstract

结论：体重指数（BMI）小于25 kg/m2并患阻塞性睡眠呼吸暂停综合症（OSAS）的患者很有可能患位置依赖性OSAS。对符合”BMI大于 25 kg/m2”和”舌肿大（TE）、腭扁桃体肥大（PTH）和Muller操作阻塞（OMM）中的任何一种症状”的患者来说, 诊断位置依赖性/位置无关性OSAS可能是困难的 。对于这类患者, 多导睡眠图一定要进行。

目的：回顾性地阐明根据患者信息和在诊所获得的上呼吸道体格检查资料来对位置依赖性OSAS进行分异的标准。

方法：将643例患者分为定位患者（PPs）或非定位患者（NPPs）。受检患者的背景因素包括性别、年龄、BMI和高血压。 对TE、PTH、咽扁桃体肥大和OMM进行评估。将偶数登记号作为训练集组（A组）, 奇数登记号作为测试用例组（B组）, 进行交叉验证。

结果：在A组, BMI 小于25 kg/m2的患者中, PP明显多于NPP。 A组中, 对于BMI大于或等于25kg/m2的患者, 发现TE、PTH和OMM有显著差异。在0和1/2/3之间发现多个因素存在显著差异。 A组产生的结果在B组中得到验证。

Keywords:

• Position-dependent obstructive sleep apnea syndrome
• body mass index
• tongue enlargement
• palatine tonsil hypertrophy
• obstruction by Muller’s maneuver
• polysomnography

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was not supported by any external funding.