• The Laryngoscope · Dec 2019

    Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?

    • Adrien Bolzer, Bruno Toussaint, Cécile Rumeau, Patrice Gallet, Roger Jankowski, and Duc Trung Nguyen.
    • Department of Ear, Nose, and Throat-Head and Neck Surgery, University Hospital of Nancy, Hospitals of Brabois, Vandoeuvre-lès-Nancy, France.
    • Laryngoscope. 2019 Dec 1; 129 (12): 2782-2788.

    Objectives/HypothesisTo assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea-hypopnea syndrome (OSAHS) in awake patients.Study DesignProspective study.MethodsAwake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal-epiglottic aerospace (RPEA), modified Cormack-Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS.ResultsThe interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack-Lehane scoring (κ = 0.38). The presence of a mega-epiglottis was significantly correlated with the severity of OSAHS (P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega-epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23-18.56, P = .024), modified Cormack-Lehane score of 2 (aOR: 15.3, 95% CI: 1.8-130.3, P = .012), or modified Cormack-Lehane score of 3 (aOR: 10.03, 95% CI: 1.3-78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01-1.14, P = .025).ConclusionsRoutine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega-epiglottis, and modified Cormack-Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients.Level Of Evidence2 Laryngoscope, 129:2782-2788, 2019.© 2019 The American Laryngological, Rhinological and Otological Society, Inc.

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