Arytenoid Asymmetry in Patients with Moderate-to-High Risk of Obstructive Sleep Apnea: A Retrospective Analysis

To investigate the prevalence of arytenoid asymmetry (AA) during phonation in patients with moderate-to-high risk of OSA.

Retrospective chart review METHODOLOGY: The medical records and video recordings of consecutive patients who presented to the sleep apnea clinic between June 2022 and December 2022 were reviewed. The risk of OSA was assessed using the STOP-BANG questionnaire. Healthy subjects with no history of sleep disorders matched by age and gender were included as a control group. Demographic data included age, gender, body mass index (BMI), history of smoking and history of hoarseness. The primary outcome measures included three signs of AA: asymmetry of the corniculate cartilage, asymmetry of the cuneiform cartilage, and asymmetry in the aryepiglottic fold angle.

Sixty-four patients with a moderate-to-high risk of OSA referred to as the study group, and 54 with no sleep disorders referred to as the control group, were included in this study. The mean age of the study and control groups were 43.9±12.9 and 41.2±14.4 years, respectively. There was a significant difference in the prevalence of AA during phonation between the study group and controls (P < 0.001). This difference remained statistically significant after adjusting for age, BMI, smoking status, gender and history of hoarseness in a multivariable logistic regression model (adjusted P = 0.002, 95% CI: 0.004-0.295). Patients with moderate-to-high risk of OSA were 10 times more likely to have AA in comparison to controls with no history of sleep disorders (OR = 10.0, 95% CI = 3.53-28.57). When compared to the control group, the difference in the prevalence of all three arytenoid asymmetries was statistically significant (P = 0.002; P = 0.009; P = 0.045, respectively). There was a weak and nonsignificant correlation between AA and the prevalence of hoarseness (correlation coefficient = 0.159, P = 0.089).

The results of this investigation indicate a significantly higher prevalence of AA during phonation in patients with moderate-to-high risk of OSA in comparison to healthy controls with no history of sleep disorders. Future investigations on the correlation between AA and phonatory symptoms in patients with moderate-to-high risk of OSA and dysphonia are warranted.