Novel grading system for quantifying upper-airway obstruction on sleep endoscopy.

Area of Science:

• Otolaryngology
• Sleep Medicine
• Respiratory Medicine

Background:

• Obstructive sleep apnea/hypopnea syndrome (OSAHS) requires effective diagnostic tools.
• Current methods for quantifying sleep endoscopy findings in OSAHS are limited.
• There is a need for a clinically applicable system to assess upper airway obstruction.

Purpose of the Study:

• To introduce a novel, anatomically comprehensive, and clinically applicable system for quantifying sleep endoscopy findings in OSAHS patients.
• To develop a severity index (SI) based on obstruction patterns identified during sleep endoscopy.
• To evaluate the correlation of the SI with established OSAHS metrics.

Main Methods:

• Fifty-five adult OSAHS patients underwent midazolam-induced sleep endoscopy.
• Five upper airway sites (nose/nasopharynx, uvulopalatine plane, tongue base, larynx, hypopharynx) were assessed for obstruction severity (grade 1 or 2).
• A severity index (SI) was calculated by summing the obstruction grades; SI was correlated with respiratory disturbance index (RDI) and body mass index (BMI).

Main Results:

• The SI showed a significant correlation with RDI (R=0.746, P<0.0001), predicting disease severity with 65% accuracy.
• No association was found between SI and BMI.
• Tongue base and hypopharynx obstruction significantly correlated with overall obstruction severity, with tongue base obstruction being a strong predictor.

Conclusions:

• The developed endoscopic grading system offers an accurate method for visualizing upper airway obstruction patterns in OSAHS.
• This easy-to-use system is a promising tool for estimating the location and severity of upper airway disease.
• The findings suggest potential implications for optimizing treatment planning in OSAHS management.