Physical Examination
Physical examination of patients with suspected OSA relates to the underlying pathophysiology.
Increased risk for OSA includes: BMI 30kg/m2 or more, waist circumference male 102cm or more, female 88cm or more, neck circumference male 42cm or more female 39cm or more. Less common risk factors are enlarged tonsils and craniofacial abnormalities (e.g. small mandible).
Physical examination includes body weight and height (to calculate body mass index (BMI, kg/m2) re obesity), neck circumference, assessment of mouth-throat (e.g. using the Modified Mallampati score 1 or Friedman Scoring Tool), dental condition, presence of nasal polyps, rhinitis or any deformity of the nose, and examination of the respiratory, cardiovascular and neurological systems (See Presentation & Risk Factors).
Table. Examination related to risk factors of OSA
| Anatomical factors predisposing to OSA |
Obesity Measure weight and height and calculate Body mass index (BMI kg/m2) Obesity (BMI >30kg/m2) increases =OSA risk Morbid obesity (BMI >40kg/m2) increases risk of hypoventilation syndrome (i.e. chronically elevated PaCO2) Waist circumference Measure at the level of the umbilicus >102cm in males and >88cm in females increases OSA risk Large neck circumference >42cm in males and >39cm in females increases OSA risk Reduced nasal patency Crowded pharyngeal airway e.g., macroglossia, tonsillar hypertrophy, Mallampati Score of III or IV especially if associated with nasal obstruction Abnormal facial appearance e.g., maxillary hypoplasia, retrognathia, micrognathia, hypothyroid or acromegalic facies |
Other conditions which are associated with an increased risk of OSA |
Hypertension Measure blood pressure (mmHg) Type 2 Diabetes Cardiovascular disease e.g., atrial fibrillation, congestive heart failure, stroke Depression Pregnancy (second and third trimesters) |
Modified Mallampati Score
Perform assessment with patient sitting up straight, mouth open and tongue maximally protruded without speaking or making a sound. A high Mallampati score of III or IV represents a predisposing factor for obstructive sleep apnoea syndrome, especially if associated with nasal obstruction. 2, 3
Class 0: Ability to see any part of the epiglottis upon mouth opening and tongue protrusion
Class I: Soft palate, fauces, uvula, pillars visible
Class II: Soft palate, fauces, uvula visible
Class III: Soft palate, base of uvula visible
Class IV: Soft palate not visible at all
Figure. Modified Mallampati Score
AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset