BRIEF RESEARCH REPORT article
Front. Sleep
Sec. Sleep and Breathing
Volume 4 - 2025 | doi: 10.3389/frsle.2025.1652532
This article is part of the Research TopicNovel technologies in the diagnosis and management of sleep-disordered breathing: Volume IIIView all 12 articles
Scalloped Tongue: An Additional, Accessible and Useful Tool to detect Severe Obstructive Sleep Apnea?
Provisionally accepted
Francisca Nieto Guimarães1*
Joana Canadas1Maria Gonçalves Cunha1
Vera Durão1Paula Rosa2
MARCELO RABAHI3
Ding Zou4
Flávio Magalhães da Silveira5- 1Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
- 2Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
- 3Universidade Federal de Goias, Goiânia, Brazil
- 4Goteborgs universitet, Gothenburg, Sweden
- 5SleepLab Rio de Janeiro, Rio de Janeiro, Brazil
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The anatomy of the upper airway can influence the risk of obstructive sleep apnea (OSA). However, there is limited evidence supporting the link between scalloped tongue (ST) and nocturnal intermittent hypoxia. This study aimed to investigate if ST could serve as a clinical indicator of OSA, particularly severe OSA. Over a 4-month period from October 2023 to January 2024, 160 patients underwent level 1 polysomnography at a sleep laboratory in Brazil. Demographics, body mass index (BMI), neck circumference (NC), presence of ST, Epworth Sleepiness Scale score, apnea hypopnea index, oxygen desaturation index (ODI) and time under 90% of oxygen saturation were included in a database. Logistic and multiple linear regression models were performed. A p-value <0.05 was considered as the lower threshold of significance. Most (90%) patients had OSA, 41% classified as severe. Older age and a wider NC significantly increased the risk of OSA. Older age, higher BMI, wider NC, and ST significantly increased the risk of severe OSA, and there was a statistically significant positive correlation between the presence of ST and ODI (p=0.001). The presence of ST increased ODI by 6.723/h, adjusted for age, BMI, and NC. The combined presence of NC ≥ 40cm and ST significantly increased the risk of severe OSA (OR 4.210, p<0.001), and significantly impacted ODI estimates. Incorporating tongue and NC assessment in OSA screening, both objective and easily observable clinical signs, may help physicians in the prompt identification of severe cases that benefit from early positive airway pressure therapy.
Keywords: scalloped tongue, Severe OSA (obstructive sleep apnea), Hypoxic burden, diagnosis, Primary Care
Received: 23 Jun 2025; Accepted: 04 Aug 2025.
Copyright: © 2025 Guimarães, Canadas, Cunha, Durão, Rosa, RABAHI, Zou and Magalhães da Silveira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Francisca Nieto Guimarães, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
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