Correlation of Mallampatti Score With Severity of OSA

Abstract

SESSION TITLE: Sleep 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: 1.To assess the presence and severity of OSA in relation to different class severity of modified Mallampatti(MPT) score from 1-4. 2. To see if we can confidently predict a positive yield on PSG beforehand as PSG is an expensive procedure and patients themselves are the payer’s in vast majority of patients in India. METHODS: Data was accessed for 681 patients who presented from Sept 2011 to Sep 2016 with symptoms of sleep disordered breathing (SDB). MPT score of all selected subjects was measured along with Epworth Sleepiness Scale (ESS) before polysomnography. MPT was measured by same physician. All subjects had undergone level-1 Overnight Polysomnography study with Split night protocol. The PSG records were scored manually and revalidated by a single senior sleep specialist. Modified MPT score was used with grading of I-IV.OSA was defined as an AHI of 5 or greater. AHI of 5-15 being labelled as Mild OSA, with AHI of 16-30 being Moderate and AHI of more than 30 labelled as Severe OSA. RESULTS: In our study a total of 681 patients were studied. OSA was present in majority of patients (97.9%). The mean age of patients was 50.83 (±17.95) years.Five hundred and fifty eight (558) i.e 81.9% patients in our study were male who presented to us. Mean BMI was 31.60±6.04. Mean Epworth sleep score was 10.91 ±5.14. Mean MPT score was 3.10±0.84. Patients had MPT class I in 29 (4.3%), class II in 124(18.2%), class III in 281 (41.3%), class IV in 247 (36.3%). OSA was present in 667 (97.9%) patients. It was mild in 83 (12.4%), moderate in 163(24.4%) and severe in 421 (63.1%). Class I MPT patients were 27 in total who had mild OSA in 9(33%), moderate OSA in 11(40.7%) and severe OSA in 7 (25.9%). Class II MPT patients were 120 in total who had mild OSA in 29 (24.2%), moderate OSA in 34 (28.3%) and Severe OSA in 57 (47.5). Class III MPT patients were 276 in total who had mild OSA in 27 (9.8%), moderate OSA in 71(25.7%) and severe OSA in 178 (64.5%). Class IV MPT patients were 244 in total and who had mild OSA in 18(7.4%), moderate OSA in 47(19.3%) and severe OSA in 179 (73.4%). CONCLUSIONS: Presence and severity of OSA is directly related to MPT score. The higher the MPT score the greater is the probability of more severe disease. Patients with class III and IV MPT have a high probability of falling in severe OSA category. MPT class of IV and even III predicted severe OSA in 73.4 % and 64.5 respectively. CLINICAL IMPLICATIONS: The purpose of this study is not to replace PSG which is the gold standard in establishing variables of cardinal importance like fluctuation in oxygen saturation, sleep arousals, the percentages of various sleep stages especially slow wave and REM sleep, other variables like cardiac rhythm disturbances, blood pressure fluctuations and abnormal limb movements etc. However, a good clinical history and physical coupled with MPT score helps us predict the presence and severity of OSA before the patient is even subjected to PSG. DISCLOSURE: The following authors have nothing to disclose: Manjit Kanwar, Dixit Thakur, Girish Raheja, Priyadarshi Kumar, Ameet Kishore No Product/Research Disclosure Information