The upper airway in sleep-disordered breathing: a clinical prediction model

An examination of the upper airway in patients with suspected sleep disordered breathing (SDB) is recommended prior to nighttime polysomnography (PSG) despite a reported low predictive value of those examinations. The aim of this study was to evaluate the data of the clinical examination and to create a clinical prediction model.

Retrospective cohort study.

A recently introduced method of dynamic examination of the upper airway during simulated snoring (SS) in awake patients is conducted in patients with suspected SDB. Clinical parameters, body mass index (BMI), and the Epworth sleepiness scale (ESS) scores of 622 patients were included in a clinical prediction model and correlated to the apnea-hypopnea index (AHI).

A correlation was detected between the AHI and alterations of the upper airway during SS, BMI, and ESS score. A clinical prediction model including clinical data, BMI, and ESS score revealed a high sensitivity but low specificity predicting the nocturnal AHI: calculated AHI = tonsil size x 2.648 + uvula size x 3.776 + dorsal movement during SS x 2.842 + collapse at tongue base level during SS x 4.769 + BMI x 0.609 + ESS score x 1.177 - 27.685.

The dynamic examination of the upper airway during SS in awake patients in combination with clinical data, the BMI, and ESS score is an easy-to-perform screening procedure prior to nighttime PSG and might support the otorhinolaryngologic diagnostic approach in patients with suspected SDB.