SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

PHYSICAL EXAMINATION IN OBSTRUCTIVE SLEEP APNEA

Süreyya Hikmet Kozcu

Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Otorhinolaryngology, Muğla, Türkiye

Kozcu SH. Physical Examination in Obstructive Sleep Apnea. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.33-43.

ABSTRACT

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder affecting approximately 1 billion adults worldwide, characterized by recurrent episodes of complete or partial upper airway collapse during sleep. These events lead to oxygen desaturation (typically below 90%), sleep fragmentation, and excessive daytime sleepiness, with significant cardiovascular and metabolic consequences including hypertension, coronary artery disease, and insulin resistance. The physical examination serves as a critical diagnostic tool, enabling clinicians to identify anatomical risk factors, predict disease severity, and guide personalized treatment decisions. The standardized examination protocol begins with anthropometric measurements, where a body mass index (BMI) ≥30 kg/m² (particularly ≥35 kg/m²) and neck circumference >43 cm in males or >40 cm in females represent significant risk factors. Craniofacial assessment focuses on identifying retrognathia (SNA angle <80°), micrognathia, and maxillary constriction through careful inspection and cephalometric analysis when indicated. Nasal examination includes evaluation of septal deviation using anterior rhinoscopy, assessment of nasal valve collapse via Cottle maneuver, and grading of turbinate hypertrophy (mild: ≤50% obstruction, moderate: 5075%, severe: >75%). The oropharyngeal examination incorporates Mallampati classification (Class III-IV indicating higher risk), tonsil size grading using the Brodsky scale, uvular characteristics (length

>1.5 cm, edema, bifurcation), and Müller’s maneuver to assess dynamic airway collapse during inspiration. Laryngopharyngeal inspection evaluates tongue base hypertrophy (Edinburgh Tongue Scale), lingual tonsils, and epiglottic morphology. These findings are integrated using validated clinical scoring systems: the Friedman staging system combines palate position, tonsil size and BMI to predict surgical outcomes, while the Fujita classification categorizes anatomical levels of obstruction. Advanced diagnostic adjuncts include drug-induced sleep endoscopy (DISE) using the VOTE classification system and volumetric magnetic resonance imaging (MRI) for airway assessment. This comprehensive approach facilitates phenotype-specific treatment selection, from positive airway pressure therapy to surgical interventions like uvulopalatopharyngoplasty or hypoglossal nerve stimulation. The protocol also enhances prediction of treatment adherence and outcomes, while supporting multidisciplinary collaboration between sleep specialists, otolaryngologists, and dentists. Future research directions include standardization of examination techniques across populations, and validation of novel imaging modalities for dynamic airway assessment during sleep.

Keywords: Obstructive sleep apnea; Physical examination; Airway obstruction; Body mass index; Palatine tonsil; Tongue

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