Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome

  • Carlos O’Connor-ReinaEmail author
  • Guillermo Plaza
  • Maria Teresa Garcia-Iriarte
  • Jose Maria Ignacio-Garcia
  • Peter Baptista
  • Juan Carlos Casado-Morente
  • Eugenio De Vicente
ENT • Original Article


Purpose of this study was to evaluate whether tongue peak pressure measured using the Iowa Oral Performance Instrument is correlated with the topographic site of obstruction in patients with obstructive sleep apnea/hypopnea syndrome observed during drug-induced sleep endoscopy. Thirty-five consecutive adult patients (29 men, 6 women) were prospectively enrolled after having been diagnosed with severe obstructive sleep apnea/hypopnea syndrome by polysomnography. An apnea–hypopnea index > 30 was confirmed, and age, gender, and body mass index were recorded by Epworth Sleepiness Scale questionnaire, and a thorough evaluation of the upper airway by video-flexible endoscopy. Twenty healthy controls according to age and sex were chosen for IOPI measurements. After drug-induced sleep endoscopy, a topographic diagnosis was done using the VOTE classification. Tongue and lip peak pressures were both measured using the Iowa Oral Performance Instrument in all patients and in 20 healthy controls. Main outcomes and measures: the correlations between office findings, Iowa Oral Performance Instrument measures, and the VOTE tongue classification during drug-induced sleep endoscopy (T0, T1, T2) were then investigated.


The average Iowa Oral Performance Instrument tongue and lip pressure were 44.02 ± 12.29 and 15.03 ± 3.71 kPa, respectively. The Iowa Oral Performance Instrument scores were both significantly lower than values in healthy controls (P < 0.001). The VOTE classification referring to the tongue position was T0 in 13 cases (37.1%), T1 in 12 cases (34.3%), and T2 in 10 cases (28.6%). A significant correlation was found between the Iowa Oral Performance Instrument tongue pressure and the T size during drug-induced sleep endoscopy (Kruskal–Wallis χ2 25.82; P ≤ 0.001).


In our experience, the Iowa Oral Performance Instrument is a useful tool for evaluating tongue collapse for the topographic diagnosis of patients with obstructive sleep apnea/hypopnea syndrome.


Tongue peak pressure Sleep apnea Drug-induced sleep endoscopy 



Dr. Carlos O’Connor Reina, Dr. Peter Baptista Jardin, and Dr. Guillermo Plaza Mayor had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dra Garcia Iriarte, Dr. De Vicente, and Dr. Casado special contribution in data collection and writing and editing assistance.

Dr. Ignacio-Garcia assisted in the translation and statistics.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

This work was approved by the ethical committee of the Consejería de Salud de la Junta de Andalucía, code AWGAPN-2019-01.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Carlos O’Connor-Reina
    • 1
    Email author
  • Guillermo Plaza
    • 2
  • Maria Teresa Garcia-Iriarte
    • 3
  • Jose Maria Ignacio-Garcia
    • 4
  • Peter Baptista
    • 5
  • Juan Carlos Casado-Morente
    • 1
  • Eugenio De Vicente
    • 6
  1. 1.Co-Chair of Department of OtorhinolaryngologyHospital Quiron Salud Marbella & Hospital Quiron Salud Campo de GibraltarMalagaSpain
  2. 2.Chief of Department of Otorhinolaryngology. Hospital Sanitas La Zarzuela & Hospital Universitario FuenlabradaUniversidad Rey Juan CarlosMadridSpain
  3. 3.Department of OtorhinolaryngologyHospital la MercedOsunaSpain
  4. 4.Chair of Department of NeumologyHospital Quiron Salud Marbella & Hospital Quiron Salud Campo de GibraltarMalagaSpain
  5. 5.Department of OtorhinolaryngologyClinica Universitaria de NavarraPamplonaSpain
  6. 6.Department of OtorhinolaryngologyHospital Universitario Miguel ServetZaragozaSpain

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