Computer-assisted quantitative evaluation of obstructive sleep apnea using digitalized endoscopic imaging with Muller maneuver.
ABSTRACT 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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ABSTRACT: Six patients with obstructive sleep apnea were studied with our system of simultaneous video recording of the polysomnographic record and the endoscopic image from the pharyngeal airway. Preoperative and postoperative recordings were made during sleep in each patient. Tracheotomized patients recreated their preoperative laryngeal inlet obstruction and its immediate cessation by alternately opening and closing the tracheotomy tube. This demonstration coupled with the physical examination findings of "disproportionate anatomy," leads to the determination that the mechanism of obstructive sleep apnea is twofold: (1) an underlying CNS propensity to hypotonia of pharyngeal musculature during sleep and (2) either an isolated obstructive upper airway lesion or a combination of alterations in normal relationships within the upper airway that cause a passive narrowing of the upper airway. This combination of altered relationships is collectively referred to as "disproportionate anatomy."Otolaryngology Head and Neck Surgery 05/1984; 92(2):127-31. · 1.63 Impact Factor
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ABSTRACT: To assess the effectiveness of the Müller Manoeuvre in predicting surgical outcome in non-apnoeic snorers. Forty-one non-apnoeic snorers performed the Müller Manoeuvre, prior to palatal surgery for snoring. Pre-operatively and between 1.0 and 4.1 months (mean 2.5 months) post-operatively, patients were admitted overnight when their sleeping position and snoring sounds were recorded. At the time of the post-operative recordings, patients were required to complete a specifically designed questionnaire. Snore files comprising the inspiratory component of the first 100 snores whilst the patient was supine, were extracted. Snore duration (s), snore loudness (dBA), snore periodicity (%) and the energy ratios for the frequency bands 0-200, 0-250 and 0-400 Hz were calculated. Only patients who showed improvements in snore periodicity and all energy ratios were considered to be surgical successes. In addition, patients were also categorised as 'successes' or 'failures' depending on their responses to specific questionnaire questions. The effectiveness of the Müller Manoeuvre in predicting surgical outcome was then tested using these categories. The 41 patients included 35 men and 6 women. Mean age: 47 years (24-67 years). Mean PNIFR 145 (80-230). Median reported alcohol intake was 11-15 units/week (0 to 26-30 units/week). Mean BMI: 30.6 kg/m2 (24.3-47.2 kg/m2). Twenty-four patients underwent an uvulopalatal elevation palatoplasty and seventeen a traditional palatoplasty. Following the Müller Manoeuvre, patients were categorised as 'ideal', 'suboptimal, but acceptable' or 'unsuitable' for surgery. Using the acoustic parameters, 23/41 patients were considered a surgical success, whilst 18/41 were considered failures. Using the questionnaire responses, 14/40 patients were considered a surgical success, whilst 26/40 were considered failures. There was no correlation between the subjective and objective outcomes (rho=0.193; p=0.227). Neither pre-operative BMI, type of palatoplasty performed, patient gender, age, PNIFR or reported alcohol intake were confounders of surgical outcome. For patients considered 'ideal' and 'suboptimal, but acceptable', using acoustic outcomes, the Müller Manoeuvre had a specificity of 55.5% and a sensitivity of 30.4%, compared with a sensitivity of 57.7% and a specificity of 28.6% when questionnaire responses were used. If only patients considered 'ideal' were considered, the specificity was 66.7%, and the sensitivity 21.7% when using acoustic outcomes, compared with a sensitivity of 69.2% and a specificity of 78.6% when questionnaire responses were used. The Müller Manoeuvre appears to have no role in the pre-operative assessment of palatal surgery for non-apnoeic snorers.Auris Nasus Larynx 01/2007; 33(4):409-16. · 0.95 Impact Factor
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ABSTRACT: To validate the technique of sleep nasendoscopy using target controlled infusion in symptomatic patients and a control group of asymptomatic individuals. Prospective cohort study. Department of otolaryngology-head and neck surgery and anesthesia in a teaching hospital. Two groups of patients were compared and matched for their body mass index. The first group consisted of 53 patients with a history suggestive of obstructive sleep apnea. The second group consisted of 54 patients with partner-confirmed history of no snoring. These patients were undergoing anesthesia for other reasons. Both groups of patients were free of associated otorhinolaryngologic symptoms. Assessment of production of snoring or obstruction in patients with no documented history of snoring when sedation was administered as part of general anesthesia using target controlled infusion with propofol. None of the patients in the asymptomatic group snored or obstructed at any level of propofol, and this was clearly significant on comparison with the symptomatic group (P < .001). All of the symptomatic patients were induced to become symptomatic (snoring/obstruction).The Laryngoscope 04/2005; 115(3):538-40. · 1.98 Impact Factor