Role of submental ultrasound in diagnosing severe obstructive sleep apnea: A prospective diagnostic accuracy study

Background: Recent research has explored the role of submental ultrasound (US) in assessing dynamic changes in upper airway soft tissues, particularly the tongue in obstructive sleep apnea syndrome (OSAS). Aim: To investigate diagnostic potential of submental ultrasonographic parameters in diagnosing severe OSAS. Patients and methods: A prospective diagnostic study including 60 adult patients with obstructive sleep apnea confirmed by polysomnography. Submental US was used to evaluate multiple parameters at rest and during Müller’s maneuver, which were then analyzed in relation to the apnea-hypopnea index (AHI) to identify markers of severe OSAS. Results: Two equal groups of 60 patients based on AHI (< 30 vs. ≥ 30) were created. Ultrasonographic measurements showed significant increases in resting tongue base thickness (65.9 vs. 58.6 mm), and during Müller’s maneuver (64.9 vs. 58.6 mm), and a large distance between lingual arteries (32.6 vs. 28.0 mm) in the severe OSAS group (all p < 0.001). We didn’t find a significant difference in retropalatal space diameter during Müller’s maneuver (p = 0.135). The Epworth sleepiness scale scores were slightly higher, but not statistically significant in the severe group (p = 0.679). Conclusion: The submental US is a practical, effective, and noninvasive bedside modality to diagnose severe OSAS.