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      Anthropometric data as predictors of Obstructive Sleep Apnea severity

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          Abstract

          Abstract

          The Obstructive Sleep Apnea Syndrome is a chronic disease characterized by episodes upper airway collapse, and has been associated with increased cardiovascular morbidity.

          Aim

          To correlate the neck, abdominal and pelvic circumference with the AHI and oxyhemoglobin saturation in OSA patients, and to correlate these values with disease severity.

          Materials and methods

          A prospective descriptive study of 82 patients evaluated complaints suggesting OSA, from July 2008 to March 2010. All patients underwent polysomnography, an ENT clinical exam, measures of the BMI, abdominal, pelvic, and cervical circumferences. The mean, standard deviations and Spearman's correlations were analyzed.

          Results

          The mean AHI in men was 39 events/hr; in women it was 21 events/hr in women. The mean neck circumference was 34.5 cm in women and 41.3 cm in men, the mean abdominal circumference was 94.3 cm in women and 101.5 cm in men, and the pelvic circumference was 105.7 cm in men and 108.7 cm in women. The neck circumference correlated more closely to the AHI in men (r=+0.389 p=0.001). The relationship between the abdominal circumference correlated more with AHI than with the BMI in men (AbC r=+0.358 p=0.003 BMI r=+0.321 p=0.009).

          Conclusion

          The neck circumference is the best anthropometric measurement of respiratory disorder severity compared to the AbC or the BMI.

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          Most cited references13

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          Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome.

          Neck circumference has been suggested to be more predictive of obstructive sleep apnoea than general obesity, but the statistical validity of this conclusion has been questioned. Combining neck circumference with other signs and symptoms may allow the clinical diagnosis or exclusion of sleep apnoea to be made with reasonable confidence. This study examines these issues. One hundred and fifty patients referred to a sleep clinic for investigation of sleep related breathing disorders completed a questionnaire covering daytime sleepiness, snoring, driving, and nasal disease. Body mass index and neck circumference corrected for height were measured and obstructive sleep apnoea severity was quantified as number of dips in arterial oxygen saturation (SaO2) of more than 4% per hour of polysomnography. Multiple linear regression was used retrospectively to identify independent predictors of SaO2 dip rate, and the model derived was then prospectively tested in a further 85 subjects. The retrospective analysis showed that the question "Do you fall asleep during the day, particularly when not busy?" was the best questionnaire predictor of variance in the SaO2 dip rate (r2 = 0.13); no other question improved this correlation. This analysis also showed that neither body mass index nor any of the questionnaire variables improved the amount of variance explained by height corrected neck circumference alone (r2 = 0.35). A statistically similar prospective analysis confirmed this relationship (r2 = 0.38). Prospective study of these patients referred to a sleep clinic with symptoms suggesting sleep apnoea shows that neck circumference corrected for height is more useful as a predictor of obstructive sleep apnoea than general obesity. None of the questionnaire variables examined add to its predictive power, but alone it is inadequate to avoid the need for sleep studies to diagnose this disease.
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            The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome.

            We have studied the predictive importance of neck circumference, obesity, and several radiographic pharyngeal dimensions for obstructive sleep apnoea (OSA), in 66 patients. OSA was quantified as the mean hourly number of greater than 4% dips in arterial oxygen saturation during sleep. Neck circumference (correlation coefficient (r) = 0.63, 95% confidence interval (C.I.) 0.46-0.76), obesity index (r = 0.54, 95% C.I. 0.39-0.69), hyoid position (r = 0.40, 95% C.I. 0.17-0.59), soft palate length (r = 0.31, 95% C.I. 0.08-0.51), and hard palate-to-spine angle (r = 0.29, 95% C.I. 0.04-0.49), correlated significantly with saturation dips in single regression analysis. In stepwise multiple linear regression analysis (saturation dip rate as the dependent variable), only neck size and retroglossal space were significant independent correlates (total r2 = 0.42, 95% C.I. 0.22-0.61, p less than 0.0001). We conclude that the relationships between general obesity, hyoid position, soft palate length, and OSA are probably secondary to variation in neck circumference.
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              Do patients with obstructive sleep apnea have thick necks?

              During physical examination of patients with suspected obstructive sleep apnea (OSA), a comment is frequently made that they appear to have a short and fat neck. To confirm this subjective impression by objective measurements, we studied a group of 123 patients referred to us because of snoring and suspected OSA, all of whom had nocturnal polysomnography and measurements of external and internal neck circumference. The external neck circumference was measured at the level of the superior border of the cricothyroid cartilage. Internal neck circumferences were calculated from the measurements of pharyngeal, glottic, and tracheal areas obtained by the acoustic reflection technique. Internal pharyngeal circumference was further subdivided into the proximal, middle, and distal thirds. The acoustic technique also permitted us to measure the distance between the teeth and the glottic minimum, which reflects the length of the upper airway. Stepwise multiple linear regression analysis revealed that the apnea/hypopnea index (AHI) correlated only with the external neck circumference, the body mass index, and the internal circumference of the distal pharynx; these three variables accounted for 39% of the variability in AHI. We conclude that the external and internal neck circumferences and the degree of obesity are important predictors of sleep apnea; it is possible that obesity produces its effect via fat in the neck. We speculate that the static pharyngeal size modulated by the dynamic loading of the airway due to the weight of fatty tissue of the neck may contribute to the pathogenesis of OSA.
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                Author and article information

                Contributors
                Journal
                Braz J Otorhinolaryngol
                Braz J Otorhinolaryngol
                Brazilian Journal of Otorhinolaryngology
                Elsevier
                1808-8694
                1808-8686
                19 October 2015
                Jul-Aug 2011
                19 October 2015
                : 77
                : 4
                : 516-521
                Affiliations
                [1 ]Otorhinolaryngologist. Head/Chief
                [2 ]Medical doctor otorhinolaryngologist. Assistant at the Otorhinolaryngology and Head & Neck Surgery Nucleus, São Paulo
                [3 ]Medical doctor. otorhinolaryngologist. Assistant at the Otorhinolaryngology and Head & Neck Surgery Nucleus, São Paulo
                [4 ]Medical resident in otorhinolaryngology - Otorhinolaryngology and Head & Neck Surgery Nucleus, São Paulo
                [5 ]Medical resident in otorhinolaryngology - Otorhinolaryngology and Head & Neck Surgery Nucleus, São Paulo
                [6 ]Medical resident in otorhinolaryngology - Otorhinolaryngology and Head & Neck Surgery Nucleus, São Paulo
                Author notes
                [* ]Send correspondence to: José Antonio Pinto - Alameda dos Nhambiquaras, 159, São Paulo - SP. CEP: 04090-010. Tel. (11) 5573-1970 japorl@ 123456uol.com.br
                Article
                S1808-8694(15)30687-X
                10.1590/S1808-86942011000400017
                9450781
                21860980
                9af722b3-b4cb-40c2-a8b9-d9efa5ac6b4f
                © Neck Surgery Nucleus. São Paulo).

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Categories
                Original Article

                obesity,obstructive,polysomnography,sleep apnea
                obesity, obstructive, polysomnography, sleep apnea

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