Evaluation of airway obstruction by nasopharyngoscopy: comparison of the Müller maneuver versus induced sleep

Abstract

The use of nasopharyngoscopy during the application of intrathoracic pressure (Müller maneuver) is frequently employed to establish the site of upper airway obstruction. The Müller maneuver, however, is used when the patient is awake and therefore may not correlate with obstruction occurring during sleep.

Aim: To compare the degree of pharyngeal obstruction in the retropalatal and retroglossal regions during the Müller maneuver versus induced sleep using nasopharyngoscopy.

Study design: A prospective, case series study.

Material and methods: Eight patients (three males, five females), with a mean age of 48.6 +/- 9.2 year, underwent nasopharyngoscopy to assess airway anatomy and function during the Müller maneuver while awake and during sleep induced by drip infusion of Midazolam.

Results: Retropalatal obstruction was similar during the Müller maneuver and sleep (mean + standard deviation = 3.13 +/- 0.99 and 2.75 +/- 0.46, p= 0.234). Retroglossal obstruction was significantly lower during Müller maneuver compared to sleep (mean + standard deviation 0.63 +/- 1.06 and 2.63 +/- 1.30, respectively, p= 0.005).

Conclusions: The sleep inducing method was safe under the monitored conditions of this study, and detected more retroglossal obstruction than the Müller maneuver.

Figure 1

Müller’s maneuver through intermittent nasal occlusion and maximum inspiration. We used a manovacuometer for pressure recording.

Chart 1

Obstruction levels seen during Müller’s maneuver and during induced sleep in the retropalatal and retrolingual areas

Figure 2

Polysomnography during nasal endoscopy under induced sleep.

Chart 2

Retrolingual region collapse estimated by Müller’s maneuver and induced sleep.