Comparison of methods of airway evaluation in obstructive sleep apnea syndrome.

OBJECTIVE: Head and neck examination, endoscopy, and cephalometric x-ray films poorly predict surgical success in obstructive sleep apnea. It is hypothesized that accurate measures demonstrate agreement and may statistically "cluster."

METHODS: Forty-two white men from a convenience sample of 60 patients had physical examinations, upper airway endoscopies, and cephalometric x-ray films reviewed. Clinically important groupings or those with linear correlation (> 0.05) were assessed with linear and logistic regression (P < 0.05).

RESULTS: Apnea hypopnea index was related to body mass index (b = 3.4, p < 0.0001), posterior wall redundancy (b = 32.8, P = 0.0004), and endoscopic retropalatal size (b = 29.5, P = 0.0046). Endoscopic retropalatal area was negatively correlated to the cephalometric posterior airway space (b = 3.4, P < 0.0003). Müller's maneuver and Malampatti scores were not associated with any measures.

CONCLUSIONS: Few features on airway evaluation associate or cluster in patients with obstructive sleep apnea syndrome. Supine endoscopy may be promising because it is associated with both the apnea hypopnea index and posterior airway space.