Physical examination The physical examination is useful mainly for identifying signs associated with obstructive sleep apnea: Obesity with fat distributed around the neck or midriff Large neck circumference (≥ 43.2 cm [17 in] in males, ≥ 40.6 cm [16 in] in females) Mandibular hypoplasia and retrognathia Nasal obstruction Enlarged tonsils (palatine or lingual), adenoid, tongue, uvula, lateral walls of the pharynx or soft palate (modified Mallampati score 3 or 4—see figure Modified Mallampati scoring) Decreased pharyngeal patency Redundant lateral pharyngeal mucosa Modified Mallampati scoring Modified Mallampati scoring is as follows: Class 1: Tonsils, uvula, and soft palate are fully visible.