Navegando por Palavras-chave "anatomical abnormalities"

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    Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome
    (Lippincott Williams & Wilkins, 2003-06-01) Zonato, A. I.; Bittencourt, L. R.; Martinho, F. L.; Santos, J. F.; Gregorio, L. C.; Tufik, S.; Universidade Federal de São Paulo (UNIFESP)
    Objectives/Hypothesis: To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea-hypopnea syndrome. the aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea-hypopnea index (AHI). Study Design: Consecutive patients with obstructive sleep apnea-hypopnea syndrome who were evaluated in a public otorhinolaryngology center were studied. Methods. Adult patients evaluated previously with polysomnography met the inclusion criteria. All subjects underwent clinical history and otolaryngological examination and filled out a sleepiness scale. Physical examination included evaluation of pharyngeal soft tissue, facial skeletal development, and anterior rhinoscopy. Results. Two hundred twenty-three patients (142 men and 81 women) were included (mean age, 48 +/- 12 y; body mass index, 29 +/- 5 kg/m(2); AHI, 23.8 +/- 24.8 events per hour). Patients were distributed into two groups according to the AHI: snorers (18.4%) and patients with sleep apnea (81.7%). Sleepiness and nasal obstruction were reported by approximately half of patients, but the most common complaint was snoring. There was a statistically significant correlation between AHI and body mass index (P < .000), modified Mallampati classification (P =.002), and ogivale-palate (P < .001). the retrognathia was not correlated to AHI, but the presence of this anatomical alteration was much more frequent in patients with severe apnea when compared with the snorers (P = .05). Other correlations with AHI were performed considering multiple factors divided into two groups of anatomical abnormalities: pharyngeal (three or more) and craniofacial (two or more) abnormalities. There was a statistically significant correlation between pharyngeal landmarks and AHI (correlation coefficient [r] = 0.147, P = .027), but not between craniofacial landmarks and AHL the combination of pharyngeal anatomical abnormalities, modified Mallampati classification, and body mass index were also predictive of apnea severity. Conclusions. Systematic physical examination that was used in the present study indicated that, in combination, body mass index, modified Mallampati classification, and pharyngeal. anatomical abnormalities are related to both presence and severity of obstructive sleep apnea-hypopnea syndrome. Hypertrophied tonsils were observed in only a small portion of the patients. the frequency of symptoms of nasal obstruction was high in sleep apnea patients. Further studies are needed to find the best combination of anatomical and other clinical landmarks that are related to obstructive sleep apnea.
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    Head and neck physical examination: Comparison between nonapneic and obstructive sleep apnea patients
    (Lippincott Williams & Wilkins, 2005-06-01) Zonato, A. I.; Martinho, F. L.; Bittencourt, L. R.; Brasil, ODC do; Gregorio, L. C.; Tufik, S.; Universidade Federal de São Paulo (UNIFESP)
    Study Objectives: the purpose of this study was to apply a systematic physical examination, used to evaluate obstructive sleep apnea (OSA) patients, in nonapneic patients. Design: Study was prospective. Setting: Patients were seen in the sleep laboratory and department of otorhinolaryngology. Patients or Participants: Nonapneic patients (n = 100) were involved in the study. Interventions. 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). Measurements and Results: 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. Conclusions: 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.