Correlation of Tonsillar Size with Severity of Obstructive Sleep Apnea (OSA) in Adult Patients

Abstract

Background:
Obstructive sleep apnea (OSA) is a common disorder marked by recurrent upper airway obstruction during sleep. To evaluate the distribution of tonsillar size in adult patients with OSA and analyze its correlation with disease severity as measured by the apnea–hypopnea index (AHI).

Methods:

This prospective observational study was conducted on 50 adult patients diagnosed with OSA. Tonsillar size was graded using the Brodsky classification (Grade I–IV). Severity of OSA was determined according to AHI values obtained from overnight polysomnography: mild (5–14), moderate (15–29), and severe (≥30). Correlations between tonsillar grade and OSA severity were assessed, and mean AHI scores were compared across tonsillar grades. Statistical significance was set at p < 0.05.

Results:

The tonsillar size distribution showed that Grade II (28%) and Grade III (32%) hypertrophy were the most frequent, while Grades I and IV were observed in 20% each (Table 1). Among patients, 15 (30%) had mild OSA, 18 (36%) moderate OSA, and 17 (34%) severe OSA (Table 2). Significant correlations were found between tonsillar grade and OSA severity: Grade I was predominantly associated with mild OSA, while Grade IV was strongly correlated with severe OSA (p = 0.001) (Table 3). Mean AHI increased progressively with higher tonsillar grades: 9.5 ± 2.1 (Grade I), 16.8 ± 3.2 (Grade II), 27.5 ± 4.6 (Grade III), and 35.2 ± 6.1 (Grade IV) (Table 4).

Conclusion:

Increasing tonsillar size is directly associated with greater OSA severity in adults. Tonsillar hypertrophy, particularly Grades III and IV, strongly predicts moderate to severe OSA. Integrating tonsillar assessment into clinical evaluation may enhance risk stratification and guide treatment decisions.

Recommendation: 

Routine tonsillar grading should be incorporated into OSA evaluation to improve risk prediction and guide timely surgical or non-surgical interventions.