Development and validation of an oropharyngeal obstruction evaluation score.

OBJECTIVE: To identify standard clinical parameters that can predict the presence and severity of obstructive sleep apnea. SUBJECTS AND METHODS: Adult patients with habitual snoring completed comprehensive polysomnography and anthropometric measurements, including sex, age, body mass index (BMI), neck circumference, tonsil size grading, modified Mallampati score, and nasofibroscopy-assisted Muller's maneuver (NMM). Spearman's correlation coefficient was used to screen the significant variables. Stepwise multiple linear regression analysis was then conducted to identify the independent variables. receiver operating characteristic (ROC) curve analysis was used to quantify the predictability of the formed oropharyngeal obstruction scoring system. RESULTS: A total of 163 adults (127 men) were enrolled in the study. Tonsil size grading, modified Mallampati score, and NMM grading maneuver were predictive of  OSA and incorporated into a scoring system. This score ranged between 3 and 12, and threshold values of ≥ 8 and ≥ 9 seemed to be appropriate to identify patients at an increased risk of at least mild (AHI ≥ 5/h; AUROC = 0.935, 95%CI = 0.900-0.970, P < 0.001) and severe OSA (AHI ≥ 30/h; AUROC = 0.939, 95%CI = 0.899-0.969, P < 0.001), respectively. CONCLUSION: This study established an evaluation score for assessing the degree of oropharhygeal obstruction. The findings of the study suggest that the score may help identify patients at risk of oropharyngeal-related OSA who should have a full sleep evaluation.

Strategies in the clinical diagnosis and surgical treatment of OSAHS with multilevel obstruction.

OBJECTIVE: To examine the safety and effectiveness of individualized treatment strategies that include three principles (security, top-down and priority) for patients with obstructive sleep apnoea hypopnea syndrome (OSAHS) and multilevel obstruction who decline therapy with continuous positive airway pressure (CPAP). METHODS: Patients with OSAHS and upper airway obstruction who were diagnosed with multilevel obstruction were included in this retrospective study. Patients were evaluated for the degree of obstruction in each level. Three principles were followed in planning the appropriate intervention level and measures to reduce perioperative risks. Polysomnography indices and Epworth sleepiness scores were used to evaluate the efficacy of surgery and improvement in patients' sleepiness at ≥3 months post-surgery. RESULTS: Among 51 patients with OSAHS and multilevel obstruction, three were treated with CPAP, 41 were treated with nasopharyngeal surgery, and seven were treated with oropharyngeal surgery. No severe complications were reported. Following surgery, apnoea hypopnea index and Epworth sleepiness scores were significantly reduced, and the lowest oxygen saturation level was significantly increased. CONCLUSION: The three-principle strategy was safe and effective in planning surgical treatments for patients with OSAHS and multilevel obstruction.