A Combined Anatomical Scoring System for Upper-Airway Obstruction in OSA (ACUOS)

¹ENT specialist & Hybrid ENT surgeon, Consultant, Popular Medical College Hospital, Bangladesh
²Junior Consultant (Anaesthesia), Kurmitola General Hospital, Dhaka, Bangladesh
³Resident (ENT), National Institute of ENT, Dhaka, Bangladesh
⁴Dhaka Medical College & Hospital, Dhaka, Bangladesh

*Corresponding Author: Mostafa Kamal Arefin, ENT specialist & Hybrid ENT Surgeon, Consultant, Popular Medical College Hospital, Tel: +8801671748866; Email: [email protected]

Citation: Arefin MK, et al. (2026). A Combined Anatomical Scoring System for Upper-Airway Obstruction in OSA (ACUOS). Mathews J Otolaryngol. 5(1):14.

Copyright: Arefin MK, et al. © (2026).

ABSTRACT

Introduction: Obstructive sleep apnoea (OSA) arises from the collapse of the upper-airway during sleep and is influenced by multiple anatomical factors, including tonsillar hypertrophy, septal deviation, turbinate enlargement, tongue-base crowding, and elevated body mass index (BMI). Current clinical staging systems (e.g., Friedman) emphasize oropharyngeal compartments but often overlook nasal anatomical burden. We propose a unified anatomical scoring framework, Arefin’s Combined Upper-Airway Obstruction Score (ACUOS), which integrates nasal, palatal, and tongue-related contributors in a numeric system to guide treatment decisions in OSA.

Methods: Five anatomical contributors were selected based on their documented association with OSA severity and surgical outcomes. Each was assigned a 0–3 or 0–4 point range, totaling 0–16, with an optional adenoid modifier for pediatric cases. ACUOS staging (A–D) suggests first-line medical, surgical, or CPAP therapy.

Results: For example, a patient with tonsil grade 3 (3 points), septal obstruction grade 2 (2), inferior turbinate hypertrophy grade 2 (2), Mallampati II (1), and BMI 31 (2) scores 10 = Stage C → multilevel surgery or CPAP. ACUOS enables OPD-based anatomical guidance for OSA treatment. Conclusion: ACUOS provides a practical, bedside scoring approach to evaluate anatomical burden in OSA and assist ENT surgeons in surgical counseling and decision-making. Validation studies are required.

Keywords: Obstructive Sleep Apnoea, Airway Anatomy, Nasal Obstruction, Septal Deviation, Turbinate Hypertrophy