Reliability of Patient Self-Assessment for Modified Mallampati Score

Abstract

Free AccessDepartmentsReliability of Patient Self-Assessment for Modified Mallampati Score Kristofer J. Spurling, M.Sc, Himender K. Makker, D.M., FRCP Kristofer J. Spurling, M.Sc Address correspondence to: Kristofer Spurling M.Sc., Specialist Clinical Physiologist, Respiratory Physiology Department, North Middlesex University Hospital NHS Trust, London N18 1QX., United Kingdom0044 20 8887 28020044 20 8887 2361 E-mail Address: [email protected] Centre for Sleep Medicine, North Middlesex University Hospital, London Search for more papers by this author , Himender K. Makker, D.M., FRCP Centre for Sleep Medicine, North Middlesex University Hospital, London Search for more papers by this author Published Online:April 15, 2010https://doi.org/10.5664/jcsm.27774SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONStudies show that there is a correlation between Modified Mallampati Score (MMS) and presence and severity of obstructive sleep apnea (OSA), this measurement being a common part of patient examinations.1,2 As a screening method sleep clinics and primary care centres can use questionnaires, as this method has been shown to predict OSA prior to full polysomnography.3,4 We asked whether patients could assess their own score as part of a service-improvement audit, with the aim of validating a home-scoring system that could be added to pre-outpatient sleep clinic questionnaires, or used as a screening method in primary care.We assessed 50 patients (age range 28-76 years, mean age 52.14 years, 17 female, 33 male), referred for suspected OSA. MMS scores were taken by an experienced clinical physiologist. Once the observer had taken the measurement, standardized verbal instructions were given and patients were invited to assess their own score using a mirror in a well-lit room, comparing their view to a large MMS chart. They were instructed on posture, head position and asked not to phonate in order to standardize the view of the oropharyngeal structures.5 Once instructions were issued, no further intervention was made.Thirty-eight patients agreed with the physiologist. Seven answered within one classification, and 3 were greater than 1 classification from the physiologist. Two patients did not answer. Agreement between physiologist and patients was analyzed using Cohen's kappa and Spearman's correlation coefficient using the 95% confidence interval. Spearman's correlation showed good correlation between physiologist and patient assessments (ρ = 0.836). Both standard kappa (κ = 0.717) and weighted kappa (κ = 0.768, crediting patients who scored within 1 classification of the physiologist) show good strength of agreement between physiologist and patients.Our results show that following standardized spoken instructions, 76% of our 50 patients were able to assess their own MMS, and the majority of the remainder were able to score within one classification of an experienced observer. Statistical analysis shows good correlation and strength of agreement between physiologist and patients. Although further investigation using written instructions for the patient at home and subsequent comparison with the physiologist's scores are required to further evaluate its predictive value, self-assessed MMS score could be a valid addition to screening questionnaires as a predictor of OSA.DISCLOSURE STATEMENTThe authors have indicated no financial conflicts of interest.REFERENCES1 Nuckton TJGlidden DVBrowner WSClaman DMPhysical examination: Mallampati score as an independent predictor of obstructive sleep apneaSleep2006299038, 16895257CrossrefGoogle Scholar2 Yagi HNakata STsuge H, et al.Morphological examination of upper airway in obstructive sleep apneaAuris Nasus Larynx2008364449, 19097716CrossrefGoogle Scholar3 Stradling JRCrosby JHPredictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged menThorax1991468590, 2014507CrossrefGoogle Scholar4 Netzer NCHoegel JJLoube D, et al.Prevalence of symptoms and risk of sleep apnea in primary careChest2003124140614, 14555573CrossrefGoogle Scholar5 Tham EJGildersleve CDSanders LDMapleson WWVaughan RSEffects of posture, phonation and observer on Mallampati classificationBr J Anaesth199268328, 1739564CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 06 • Issue 02 • April 15, 2010ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationJanuary 1, 2010Accepted for publicationFebruary 1, 2010Published onlineApril 15, 2010 Information© 2010 American Academy of Sleep MedicineACKNOWLEDGMENTSThis data was collected at the Centre for Sleep Medicine, North Middlesex University Hospital NHS Trust, London N18 1QX., United Kingdom.PDF download