Abstract
Objective: To assess the number of levels of obstruction on a level 3 home sleep study in patients with obstructive sleep apnea. Study Design: This is a prospective study. Setting: Tertiary referral centre. Subjects and Methods: All the patients with the complaints of snoring, excessive daytime sleepiness, were evaluated for OSA. Complete history was taken and a thorough clinical examination was done followed by fibreoptic nasopharyngoscopy to determine the sites of obstructions. Patients were categorised into group A and group B based on the number of levels of obstruction. A level 3 home sleep study also was done for these patients. We tried to correlate the polysomnographic variables between the two groups. Results: There was a significant difference between the two groups in a number of PSG parameters. Patients in A group had lower number of apnoeas, obstructive apnoeas, hypopneas, AHI index, flow limitation and BMI as compared to patients in group B and the difference was statistically significant. We have devised a score using 3 parameters AHI, Flow limitation with snoring and BMI, the Deenadayal’s (DDS) scoring system. The minimum scoring would be 3 and maximum score would be 6. Based on scoring the probable number of obstructions can be identified. Conclusion: Sleep study report can yield a lot of information regarding the number of levels of obstruction. A critical analysis is required while doing the same. Till date there have been no reports in literature identifying number of levels of obstruction on PSG.
Highlights
Patients were categorised into group A and group B based on the number of levels of obstruction
Sleep study report can yield a lot of information regarding the number of levels of obstruction
Patients with obstructive sleep apnea who do not have isolated obstructive lesions in the upper airway must have some dynamic alteration that allows the relatively hypotonic pharyngeal walls to collapse into the inspiratory airstream
Summary
Patients with obstructive sleep apnea who do not have isolated obstructive lesions in the upper airway must have some dynamic alteration that allows the relatively hypotonic pharyngeal walls to collapse into the inspiratory airstream This disproportionate anatomy, consisting of any combination of large tongue base, long soft palate, shallow palatal arch narrow mandibular arch or retrognathic mandible, renders the patient more vulnerable to the development of relative upper airway obstruction. This alteration causes intraluminal pressure to become excessively negative and allows the underlying hypotonic pharyngeal walls to collapse [2]
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