Computer-Assisted Quantitative Evaluation of Obstructive Sleep Apnea Using Digitalized Endoscopic Imaging with Muller Maneuver

Department of Otolaryngology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
The Laryngoscope (Impact Factor: 2.14). 06/2008; 118(5):909-14. DOI: 10.1097/MLG.0b013e3181638187
Source: PubMed


To validate the technique of the Muller maneuver (MM) using videoendoscopy and to quantify the correlation between its clinical results and variables of polysomnography.
Prospective, controlled study.
Videoendoscopy with MM was performed in 70 patients who were categorized into two groups, with 35 patients giving a history suggestive of snoring and 35 patients without such history. The snoring group underwent further examination with polysomnography. Cross-sectional areas at the retropalatal (RP) and retrolingual (RL) levels during quiet respiration (RP(0) or RL(0)) and the maximal effort of MM (RP(1) or RL(1)) were calculated with the digital measurement software "Image J." One hundred forty pairs of data were acquired. The collapsing ratio (CR) was defined as the difference of RP(0) (or RL(0)) between RP1 (or RL(1)) divided by RP(0) (or RL(0)) to compare the difference between the two phases. These results were compared with each other and correlated to the variables obtained from polysomnographic studies.
There were significant differences in the CR of RP (CR(RP)), the CR of RL (CR(RL)), and body mass index (BMI) when comparing the two groups. In snoring patients, BMI was positively related to the respiratory disturbance index (RDI) and obstructive sleep apnea (OSA) staging but not to CR(RP) and CR(RL). CR(RP) had a significant positive relationship with RDI and OSA rather than CR(RL).
MM with videoendoscopy can be a simple, cost-effective, quantitative, and even predictable technique. This method allows us to examine the dynamic upper airway for more precise preoperative planning.

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    • "To avoid the complexity to induce sleep in OSA patients, the Müller maneuver, which consists of a forced inspiratory effort with the mouth and nose closed, could be applied as substitute of real sleep. This maneuver can mimic the pathophysiological condition of OSA during wakefulness, and has been applied to the studies of OSA (Ko and Su 2008; Gregorio et al. 2007; Liao et al. 2003; Terris et al. 2000; Jäger et al. 1998). A successful example of the Müller maneuver application is the evaluation of upper airway function by fiberoptic nasopharyngoscopy with this maneuver before surgical intervention to predict surgical outcome and to improve patient selection (Sher et al. 1985). "
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