Which finding most strongly suggests sleep apnea in a patient with daytime sleepiness?

Which finding most strongly suggests sleep apnea in a patient with daytime sleepiness?

• A. BMI of 27 kg/m2
• B. Mallampati score of 2
• C. Presence of retrognathia
• D. Neck circumference of 15 inches

Answer: (C)

Anatomical narrowing of the upper airway is the strongest clue for obstructive sleep apnea in someone with daytime sleepiness. Retrognathia, a jaw position where the mandible sits back, directly reduces space behind the tongue and soft palate, making the airway more prone to collapse during sleep. This structural predisposition aligns closely with the pathophysiology of sleep apnea, so it is the finding that most strongly points to the diagnosis. While being overweight (BMI around 27) increases risk, and a Mallampati score of 2 indicates some airway crowding, these are less specific predictors on their own. A neck circumference of 15 inches is not particularly large by commonly used risk thresholds, so it contributes less to the likelihood than an anatomically retrognathic jaw.

Anatomical narrowing of the upper airway is the strongest clue for obstructive sleep apnea in someone with daytime sleepiness. Retrognathia, a jaw position where the mandible sits back, directly reduces space behind the tongue and soft palate, making the airway more prone to collapse during sleep. This structural predisposition aligns closely with the pathophysiology of sleep apnea, so it is the finding that most strongly points to the diagnosis.

While being overweight (BMI around 27) increases risk, and a Mallampati score of 2 indicates some airway crowding, these are less specific predictors on their own. A neck circumference of 15 inches is not particularly large by commonly used risk thresholds, so it contributes less to the likelihood than an anatomically retrognathic jaw.