Comparison of Muller’s maneuver simulated snoring and sleep endoscopy according to VOTE classification in sleep apnea patients

Objective: In patients with obstructive sleep apnea syndrome (OSAS), it is important to determine the obstructive pathology in the upper respiratory tract (URT). Drug-induced sleep endoscopy (DISE) has been accepted as the most valuable technique for determining the obstruction site associated with sleep-disordered breathing. Simulated snoring (SimS), one of the techniques developed for this purpose, is practical; however, it is important to determine its reliability according to the standard grading methods. In this study, we aimed to compare the effectiveness of the SimS method in detecting obstructive pathology in URT with Muller maneuver (MM) and DISE according to the velum, oropharynx lateral wall, tongue base and epiglottis (VOTE) classification. Methods: Forty patients older than 18 years with OSAS diagnosis (apnea-hypopnea index [AHI] > 5) were included in the study. Obstructive findings in URT were evaluated according to VOTE classification with MM, SimS, and DISE. The patients were evaluated with MM and SimS in the polyclinic and with DISE in the operating room on different days. The obstructive pathologies in URT were evaluated and images recorded. Obstructive findings were evaluated using all three methods according to the VOTE classification. The extent of agreement of findings between the methods was evaluated using the weighted κ value Cohen. Results: The patients’ data were evaluated independently of AHI, and it was seen that SimS had a better agreement with DISE than MM. Patient grouping by AHI revealed a high level of agreement between SimS and DISE in all four regions in the group with AHI < 30. SimS and DISE findings were consistent, except lateral pharyngeal collapse was detected at the level of tongue base in patients with AHI > 30. Conclusion: The results showed that SimS was more effective than MM and provided similar findings to DISE. SimS is a more feasible alternative in the planning phase of surgical treatment of OSAS.