The prognostic value of simulated snoring in awake patients with suspected sleep-disordered breathing: introduction of a new technique of examination.

STUDY OBJECTIVE: A clinical examination of the upper airway in patients with suspected sleep-disordered breathing (SDB) is frequently performed before nighttime polysomnography. In recent years, the findings of "static" examinations, such as dorsalization of the tongue base, the Malampatti index, and Mueller maneuver, have been determined to be of low predictive value. DESIGN: We developed a new method of "dynamic" examination of the upper airway during simulated snoring in awake patients and analyzed the method in terms of the predictive value for suspected SDB. SETTING: N/A PATIENTS: One hundred thirty-one patients were examined prior to night-time polysomnography, and the results were correlated with the apneahypopnea-index (AHI). INTERVENTIONS: N/A RESULTS: A significant correlation was detected between an increased dorsal movement of the tongue base, as well as with pharyngeal collapse at the level of the tongue base and the AHI. Pharyngeal collapse at the level of the velum did not correlate with the AHI. The patient's body position during simulated snoring did not influence the results. The "static" examinations, such as the dorsalization of the tongue base, tonsil size, Malampatti index, and Mueller maneuver, did not correlate with the AHI. Patients with a high degree of pharyngeal collapse at the level of the tongue base, in combination with dorsal movement of the tongue base during simulated snoring, revealed a probability of 75% to have an AHI more than 10 and of 92% for an AHI more than 5. CONCLUSION: The "dynamic" examination of the upper airway under simulated snoring in awake patients is an easy-to-perform method to predict the probability of SDB prior to nighttime polysomnography.

Pseudoaneurysm of the lingual artery after temperature-controlled radiofrequency tongue base reduction: a severe complication.

Temperature-controlled radiofrequency reduction (TCRF) of the tongue base has been developed as an alternative option for the treatment of patients with obstructive sleep apnea syndrome. The technique is propagated as an easy and safe surgical method. The case of a 34-year-old male patient with obstructive sleep apnea syndrome who underwent TCRF is reported. Fourteen days after surgery was performed, heavy bleeding at the base of the tongue occurred. Computed tomography and digital subtraction angiography imaging revealed a pseudoaneurysm of the lingual artery, which was treated endovascularly by detachable and free platinum coils during the same session. The article reports the first case of pseudoaneurysm under TCRF of the tongue base and discusses the diagnostic and therapeutic procedure to handle and avoid life-threatening complications under this method of treatment.