*2.2.4 Pharynx examination*

There are two well-defined classifications to identify the relationship of the tongue with the pharynx. The Mallampati classification is a method first used by anesthesiology specialists to foresee difficult tracheal intubations. Friedman classification describes prognostic indicators for a successful surgery for sleep disorders by combining the position of the palate with the size of the tonsils [20, 21]. The Mallampati classification is as follows:

Class 1: Soft palate, fauces, uvula, and posterior and anterior pillars are visible. Class 2: Soft palate, fauces, and uvula are visible. Class 3: Soft palate, fauces, and only the base of uvula are visible. Class 4: Soft palate is not visible.

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*Diagnosis*

*DOI: http://dx.doi.org/10.5772/intechopen.91368*

Enlarged tonsils and adenoids are the primary causes of upper airway obstruction and sleep apnea in children, only a small portion of the adults can have an enlargement of these structures leading to obstruction of the airways. Adenoids cannot be visualized during a routine physical examination or the examination of tonsils, and a tongue depressor might be necessary. The size of the tonsils can be

During physical examination, the characteristics of the apparent neuromuscular

disease can indicate OSA and hypoventilation. For example, progressive muscular atrophy and hand or tongue fasciculations can indicate amyotrophic lateral sclerosis. In amyotrophic lateral sclerosis, phrenic nerve dysfunction is common; during rapid eye movement sleep (REM) it leads to diaphragmatic paralysis due to significant hypoventilation. Furthermore, coexisting OSA can reveal itself during amyotrophic lateral sclerosis with bulbar involvement. In poliomyelitis, there is weakness of thoracoabdominal muscles and accessory muscles of respiration; this can frequently be accompanied with kyphoscoliosis. Postpolio syndrome demonstrated itself with muscular dystrophies; myasthenia gravis and metabolic myopathies exhibit themselves with weaknesses of chest wall muscles and the diaphragm. Myasthenia gravis can as well involve facial structures resulting in OSA. In myotonic dystrophy or muscular dystrophy, there can be craniofacial abnormalities; macroglossia can also be seen (e.g., in Duchenne muscular dystrophy). Lastly, obesity (e.g., steroid use or inactivity) and being overweight can contribute to sleep

Peripheral edema is a frequent finding in patients with obesity hypoventilation syndrome (as a manifestation of cor pulmonale) as well as in certain patients with obstructive apnea that have left ventricular heart failure. OSA can coexist with chronic obstructive pulmonary disease and asthma. Hypertension is associated with OSA. If a patient with OSA has chronic pulmonary disease, pulmonary hypertension can also be seen. Findings of polycythemia, arrhythmia, cyanosis, right heart failure, and chronic

*Cephalometry*: It is the standardized lateral radiographic imaging of the head and neck with which bone and soft tissue boundaries are evaluated in individuals with OSA. It is useful in diagnosing frequently encountered craniofacial and upper airway soft tissue anatomy-related anomalies like the hyoid, mandibular, tongue, soft palate, and facial anomalies. Maxillo-mandibular retrognathism has in patients with OSA and it has been accepted as an indicator of maxillary prognathism. Horizontal and vertical length of the mandibula affects the oral floor and the position of the tongue. The length of the horizontal ramus of the mandibula shortens in individuals with snoring and apnea, whereas vertical ramus only shortens in people who snore. Total facial height is found to have increased in OSA patients compared

apnea during the course of a neuromuscular disease [23, 24].

*2.2.5 Examination of the tonsils*

measured on a scale of 1–4 [22].

*2.2.6 Neurological examination*

*2.2.7 Cardiopulmonary examination*

cor pulmonale can be identified [19, 25].

**2.3 OSA diagnostic methods**

*2.3.1 Radiological diagnosis*
