Severity of obstructive sleep apnea: Correlation with clinical examination and patient perception

Objective: To correlate clinical history, patient self-perception of obstructive sleep apnea, and physical examination with the severity of OSA. Methods: One hundred and two consecutive patients were prospectively enrolled over a 6-month period. All patients underwent a comprehensive history and clinical examination, nasopharyngoscopy, and an overnight-attended polysomnogram. Results: There were 65 males and 37 females with a mean age of 50.2 ± 11.3 years (range, 24 to 76 years). The mean apnea-hypopnea index (AHI) was 37.9 ± 27.7 (range, 0.7 to 111.2). There was a strong correlation between patient self-perception of OSA severity and AHI (r = 0.499, P < 0.0001), and the correlation with AI was 0.577 (P < 0.0001). OSA severity strongly correlated with Friedman Tongue Position grade, (r = 0.389, P < 0.0001), Friedman clinical staging, (r = 0.331, P = 0.0007). Of significance, only 6.9% of patients with mild OSA had a >50% collapse of the base of tongue region, as compared to 65.9% of patients with severe OSA. Conclusion: There is good correlation between clinical examination parameters and the severity of OSA. An algorithm for surgical treatment of OSA should acknowledge both the site of obstruction and the severity of disease.