Updated Friedman Staging System for Obstructive Sleep Apnea

In the practice of sleep medicine, the first step is identification of those patients at high risk for sleep apnea. Nearly every physician and every hospital has preferred methods of screening. Many patient questionnaires or surveys as well as some objective physical measurements have been suggested to predict the presence of sleep apnea. Screening is well established, and laboratory and home testing are widely available. An early assessment with a physical examination can help direct treatment planning. The Friedman tongue position, lingual tonsil hypertrophy grading, and the effects of oral positioning on the hypopharynx should be used in early assessment for treatment planning, and as screening tools to assess the sight of obstruction. Although these screening tools are not substitutes for drug-induced sleep endoscopy (DISE), they are crucial in early assessment as many patients do not require surgery or DISE early in the evaluation.