Head and neck physical examination: comparison between nonapneic and obstructive sleep apnea patients.

Abstract

The purpose of this study was to apply a systematic physical examination, used to evaluate obstructive sleep apnea (OSA) patients, in nonapneic patients. Study was prospective. Patients were seen in the sleep laboratory and department of otorhinolaryngology. Nonapneic patients (n = 100) were involved in the study. Physical examination to evaluate facial skeleton, pharyngeal soft tissue, rhinoscopy, and body mass index. Data were compared with a previously published study (2003) on a group of OSA patients (n = 223). Skeletal examination detected retrognathism in 6%, class II occlusion in 12%, and high-arched hard palate in 11%. The modified Mallampati classification showed 54% in class I to II and 46% in class III to IV. Only 1% of nonapneic patients had tonsils of degree III to IV. Oropharynx evaluation showed web palate in 38%, posterior palate in 19%, thick palate in 10%, thick uvula in 10%, long uvula 15%, voluminous lateral wall in 11%, and tongue edge crenations in 28%. Anterior rhinoscopy detected significant septal deviation in 1% and turbinate hypertrophy in 31% of patients. The head and neck physical examination, considering both skeletal and soft tissue alterations, illustrated significant differences between nonapneic and OSA patients. Body mass index, modified Mallampati classification, tonsils hypertrophy, and high-arched hard palate previously related to the presence of sleep apnea in the literature showed different outcomes in nonapneic patients. Nonapneic patients had less alterations in nasal anatomy (severe septal deviation and enlarged turbinate). Skeletal parameters, such as retropositioned mandible and angle class II occlusion, were less frequent in nonapneic patients.