Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?. (5th February 2019)

• Record Type: Journal Article
• Authors: Bolzer, Adrien; Toussaint, Bruno; Rumeau, Cécile; Gallet, Patrice; Jankowski, Roger; Nguyen, Duc Trung
• Is Part Of: Laryngoscope. Volume 129:Number 12(2019)
• Page Start: 2782
• Page End: 2788
• Publication Date: 2019-02-05
• Subjects: Obstructive sleep apnea‐hypopnea syndrome -- awake flexible fiberoptic laryngoscopy -- upper airway -- epiglottis -- hypopharynx; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.27851
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: To assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea‐hypopnea syndrome (OSAHS) in awake patients. Study Design: Prospective study. Methods: Awake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal‐epiglottic aerospace (RPEA), modified Cormack‐Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS. Results: The interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack‐Lehane scoring (κ = 0.38). The presence of a mega‐epiglottis was significantly correlated with the severity of OSAHS ( P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega‐epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23‐18.56, P = .024), modified Cormack‐Lehane score of 2 (aOR: 15.3, 95% CI: 1.8‐130.3, P = .012), or modified Cormack‐Lehane score of 3 (aOR: 10.03, 95% CI: 1.3‐78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01‐1.14, P = .025). Conclusions: Routine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega‐epiglottis, and modified Cormack‐Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients. Level of Evidence: 2 Laryngoscope, 129:2782–2788, 2019