Identify Patients at Risk of Moderate or Severe OSAHS During ENT Examination

To identify anatomical factors predictive of moderate/severe obstructive sleep apnea-hypopnea syndrome (OSAHS) during routine ENT examinations in awake patients.

A total of 110 patients who snore or are suspected to have OSAHS were prospectively included and underwent a standardized ENT examination coupled with recorded nasofibroscopy and sleep recording. Anatomical assessment of the upper airway was performed independently by two examiners using the recorded videos. The shape, size, and position of the epiglottis, the shape of the retro-pharyngeal space, the modified Cormack-Lehane score, and the tongue base were evaluated. An interexaminer agreement was calculated. A multivariate logistic regression model was used to assess independent predictors of moderate/severe OSA, enabling the construction of a screening model. Thresholds were defined using the ROC curve.

Interobserver agreement was excellent for the assessment of epiglottis shape/aspect (κ = 0.95), contact with the posterior pharyngeal wall (κ = 0.92), vallecula visibility (κ = 0.89), epiglottis size (κ = 0.86), and modified Cormack-Lehane score (κ = 0.86). Age > 45 years, male sex, retrovelar narrowing < 1 cm, presence of mega-epiglottis and modified Cormack-Lehane score were significantly associated with moderate/severe OSA. Multivariate analyses revealed 3 predictive factors for moderate/severe OSAHS: age > 45 years (aOR = 4, 95% CI [1.44-11.12], p = 0.008), retrovelar narrowing < 1 cm (aOR = 2.8, 95% CI [1.05-7.6], p = 0.04), and the presence of a mega-epiglottis (aOR = 4.1, 95% CI [1.49-11.23], p = 0.006).

Meticulous anatomic assessment of the upper airway during routine ENT consultations is a relevant tool for identifying patients at risk for moderate/severe OSAHS.

2 Trial Registration: Clinical Trials: NCT05808868.