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Abstract
Snoring results from the vibration of the soft tissues in the oral cavity {u2013} the soft palate, uvula, tonsils, base of tongue, epiglottis and lateral pharyngeal walls. These vibrating soft tissues when subjected to negative pressure within the upper airway may lead to collapse of the upper airway. It is known that when inspiratory trans pharyngeal pressure exceeds the pharyngeal dilating muscle action, apneas and hypopneas occur. Collapse of the upper airway is usually multilevel, at the level of the velopharynx, the base of tongue, and the lateral pharyngeal walls. Many patients with obstructive sleep apnea (OSA) have bulky thick lateral pharyngeal walls that vibrate and contribute to the collapse of the upper airway in these patients. The level of collapse is assessed using the Mueller maneuver recorded with fiberoptic flexible nasopharyngoscopy.The Mueller maneuver is usually graded on a fivepoint scale, 0 to 4