Open AccessDiagnosing Obstructive Sleep Apnea: Predictive Value of Friedman Tongue Position
Author(s) -
Friedman Michael,
Hamilton Craig S.,
Samuelson Christian G.
Publication year - 2012
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599812451426a431
Subject(s) - medicine , obstructive sleep apnea , tongue , meta analysis , odds ratio , sleep apnea , pathology
Objective 1) Assess the association between tongue position and risk of obstructive sleep apnea (OSA) as measured by both Mallampati (MP ‐including classic 3‐level and modified 4‐level scoring with tongue protrusion) and Friedman Tongue Position (FTP‐no tongue protrusion). 2) Determine which of these assessment scales best predicts OSA risk. Method PubMed, MEDLINE, Cochrane Trial Registry (through 12/2011), and relevant article bibliographies were searched. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis of studies assessing the association of tongue position and risk of OSA were performed. Outcomes are reported as odds ratios (OR). Results Combined data from 5 studies (46,264 patients) revealed an overall OR of 2.436 (1.828, 3.248; P <. 001) for presence of OSA with MP/FTP 3 or 4 compared with MP/FTP 1 or 2. Sensitivity analysis revealed OR of 2.185 (1.643, 2.905; P <. 001) for MP 3/4 and 4.408 (2.651, 7.327; P <. 001) for FTP 3/4, respectively. Combined data from 2 studies (240 patients) revealed an OR for OSA per 1‐point increase in MP/FTP of 2.351 (1.430, 3.865; P <. 001). Sensitivity analysis revealed OR of 2.5 (1.225, 5.103; P =. 012) and 2.219 (1.109, 4.437; P =. 024) per 1‐point increase in MP and FTP, respectively. Conclusion Tongue position 3 or 4, whether classified by MP or FTP, is significantly associated with increased OSA risk. In the clinical assessment of patients with suspected OSA, FTP 3/4 appears to have a higher predictive value for OSA than classic MP 3 or modified MP 3/4.