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.
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Fernández-Julián E, García-Pérez MÁ, García-Callejo J, Ferrer F, Martí F, Marco J (2014) Surgical planning after sleep versus awake techniques in patients with obstructive sleep apnea. Laryngoscope. 124(8):1970–1974. https://doi.org/10.1002/lary.24577
Eichler C, Sommer JU, Stuck BA, Hörmann K, Maurer JT (2013) Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath 17(1):63–68. https://doi.org/10.1007/s11325-012-0647-9
Kotecha B, Kumar G, Sands R, Walden A, Gowers B (2013) Evaluation of upper airway obstruction in snoring patients using digital video stroboscopy. Eur Arch Oto rhinolaryngol. 270(7):2141–2147. https://doi.org/10.1007/s00405-013-2370-y
Charakorn N, Kezirian EJ (2016) Drug-induced sleep endoscopy. Otolaryngol Clin N Am 49(6):1359–1372. https://doi.org/10.1016/j.otc.2016.06.002
Kezirian EJ, Hohenhorst W, De Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 268(8):1233–1236. https://doi.org/10.1007/s00405-011-1633-8
Blumen MB, Latournerie V, Bequignon E, Guillere L, Chabolle F (2015) Are the obstruction sites visualized on drug-induced sleep endoscopy reliable? Sleep Breath 19(3):1021–1026. https://doi.org/10.1007/s11325-014-1107-5
Eckert DJ (2018) Phenotypic approaches to obstructive sleep apnoea – new pathways for targeted therapy. Sleep Med Rev 37:45–59. https://doi.org/10.1016/j.smrv.2016.12.003
Dotan Y, Pillar G, Schwartz AR, Oliven A (2015) Asynchrony of lingual muscle recruitment during sleep in obstructive sleep apnea. J Appl Physiol 118(12):1516–1524. https://doi.org/10.1152/japplphysiol.00937.2014
Dotan Y, Pillar G, Tov N, Oliven R, Steinfeld U, Gaitini L, Odeh M, Schwartz AR, Oliven A (2013) Dissociation of electromyogram and mechanical response in sleep apnoea during propofol anaesthesia. Eur Respir J 41(1):74–84. https://doi.org/10.1183/09031936.00159611
Jordan AS, McSharry DG, Malhutra A (2014) Adult obstructive sleep apnoea syndrome. J R Coll Physicians Lond 33(5):439–444. https://doi.org/10.1016/S0140-6736(13)60734-5.Adult
Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M (2017) Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath;21(4). doi:https://doi.org/10.1007/s11325-017-1489-2
Friedman M, Salapatas AM, Bonzelaar LB (2017) Updated Friedman staging system for obstructive sleep apnea. Adv Otorhinolaryngol 80:41–48. https://doi.org/10.1159/000470859
Marchesan IQ (2012) Lingual frenulum protocol. Int J Orofacial Miology 38:89–103.PMD 23367525
De Vito A, Carrasco Llatas M, Vanni A et al (2014) European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 18(3):453–465. https://doi.org/10.1007/s11325-014-0989-6
Clark HM, Solomon NP (2012) Age and sex differences in orofacial strength. Dysphagia. 27(1):2–9. https://doi.org/10.1007/s00455-011-9328-2
Youmans SR, Stierwalt JAG. Measures of tongue function related to normal swallowing doi:https://doi.org/10.1007/s00455-006-9013-z
Adams V, Mathisen B, Baines S et al (2013) A Systematic Review and Meta-analysis of Measurements of Tongue and Hand Strength and Endurance Using the Iowa Oral Performance Instrument (IOPI). Dysphagia 28:350. https://doi.org/10.1007/s00455-013-9451-3
Clark HM, O’Brien K, Calleja A, Newcomb CS (2009) Effects of directional exercise on lingual strength. J Speech, Lang Hear Res 52(4):1034–1047. https://doi.org/10.1044/1092-4388(2009/08-0062)
Normal Values. From https://iopimedical.com/normal-values/
Berry S, Roblin G, Williams A, Watkins A, Whittet HB (2005) Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope. 115(3):538–540. https://doi.org/10.1097/01.mlg.0000157849.16649.6e
Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI (2003) Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 168(5):522–530. https://doi.org/10.1164/rccm.200208-866OC
Soares Oliveira MC, Tufik S, Louise Martinho Haddad F, Santos-Silva R, Gregório LC, Bittencourt L (2015) Systematic evaluation of the upper airway in a sample population. Otolaryngol-Head and Neck Surgery 153(4):663–670. https://doi.org/10.1177/0194599815577598
Carberry JC, Amatoury J, Eckert DJ (2018) Personalized management approach for OSA. Chest. 153(3):744–755. https://doi.org/10.1016/j.chest.2017.06.011
Marques M, Genta PR, Sands SA, et al. (2017) Effect of sleeping position on upper airway patency in obstructive sleep apnea is determined by the pharyngeal structure causing collapse. Sleep ;40(3). doi:https://doi.org/10.1093/sleep/zsx005
Kotecha BT, Hannan SA, Khalil HMB, Georgalas C, Bailey P (2007) Sleep nasendoscopy: a 10-year retrospective audit study. Eur Arch Otorhinolaryngol. 264(11):1361–1367. https://doi.org/10.1007/s00405-007-0366-1
Hewitt RJD, Dasgupta A, Singh A, Dutta C, Kotecha BT (2009) Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction? Eur Arch Otorhinolaryngol. 266(5):691–697. https://doi.org/10.1007/s00405-008-0831-5
Pang KP, Baptista PM, Olszewska E et al (2019) Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients. Laryngoscope. https://doi.org/10.1002/lary.27987
O’Connor Reina C, Plaza Mayor G, Ignacio-Garcia J, et al (2019) “Floppy Closing Door Epiglottis Treated Successfully with an Mhealth Application Based on Myofunctional Therapy: A Case Report,” Case Reports in Otolaryngology, vol. 2019, Article ID 4157898, 4 pages. https://doi.org/10.1155/2019/4157898
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.
Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
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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O’Connor-Reina, C., Plaza, G., Garcia-Iriarte, M.T. et al. Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome. Sleep Breath 24, 281–286 (2020). https://doi.org/10.1007/s11325-019-01952-x
- Tongue peak pressure
- Sleep apnea
- Drug-induced sleep endoscopy