Modified Mallampati Score Research Articles

Waist circumference and postmenopause stages as the main associated factors for sleep apnea in women: a cross-sectional population-based study.

The current study aimed to investigate stages of reproductive aging as an associated factor for obstructive sleep apnea syndrome (OSAS) among women in a representative sample of Sao Paulo, Brazil. Four hundred seven women underwent clinical evaluation, polysomnography, and biochemical analysis. Stages of reproductive aging were defined as premenopause, early postmenopause, and late postmenopause. OSAS was more frequent in the postmenopausal groups, with 68.4% of women affected by severe OSAS belonging to the late postmenopause group. After adjustment for potential confounding factors, associated factors for OSAS, regardless of its severity, were waist circumference, modified Mallampati score IV, and both postmenopause stages. For moderate to severe OSAS and severe OSAS, we found waist circumference and both postmenopause stages to be the main factors. We carried out a receiver operating characteristic curve analysis, which demonstrated that the cutoff value for waist circumference was 87.5 cm, with a maximum of 75.7% accuracy for the classification of women as OSAS or non-OSAS. OSAS is prevalent in postmenopausal women, especially in late postmenopause. This study highlights the association between waist circumference, early postmenopause and late postmenopause, and severity of OSAS. Our findings suggest that postmenopause stages may potentially exacerbate the presence of sleep disturbance and that reducing waist circumference may be an important strategy for managing OSAS in women.

Otolaryngological Manifestations in Mucopolysaccharidoses

Objectives: (1) Describe the most prevalent findings of anamnesis and physical otolaryngologic examination in patients with mucopolysaccharidoses (MPSs), which are a lysosomal storage disorder group caused by deficiency of enzymes involved in catabolism of glycosaminoglycans. (2) Evaluate the importance of a multidisciplinary approach for MPSs patients. Methods: A descriptive cross-sectional (prevalence) study performed in January 2014. Thirty-four MPSs patients followed at a tertiary teaching hospital were invited, from which 25 participated from the study, with agreement of their families. Questionnaires were answered by their parents and a physical examination was done. The analyzed variables were otologic, pharyngolaryngeal, and nasal and respiratory signs and symptoms. Results: Among the evaluated patients, 52% (13/25) were male and 48% (12/25) female. The average age was 12.44 years at examination and 5.14 years at MPS diagnosis. The most frequent subtype was MPS VI (12/25). Hearing complaints were present in 60% (15/25) of patients, snoring in 44% (11/25), with witnessed sleep breathing pauses in 24% (6/25). The number of pharyngotonsillitis and upper airway infections was 1.68 and 3.36 episodes in the past year, respectively. Important findings on physical examination were: hyperplastic gums (60%-15/25), modified Mallampati score IV (64%-16/25), tonsil size grade III (60%-16/25), flattened nasal pyramid (80%-20/25), and tympanic retraction (24%-6/25). Conclusions: There is a high prevalence of ear, nose, and throat manifestations that requires further investigation and possibly intervention, such as suspected respiratory sleep disturbances and hearing loss. There was a similar prevalence of respiratory tract infections as expected for age. Results support recommendation for multidisciplinary approach.

Role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopy.

BackgroundThe aim of this study was to determine if ultrasound (US) measurements of anterior neck soft tissue thickness at hyoid bone (DSHB), thyrohyoid membrane (DSEM), and anterior commissure (DSAC) levels can be used to predict difficult laryngoscopy.Material/MethodsWe included 203 patients age 20–65 years scheduled to undergo general anesthesia in this prospective observational study. Correlation analysis and receiver operating characteristic curve (ROC) analysis were used to determine the roles of screening tests [interincisor gap (IIG), thyromental distance (TMD), modified Mallampati score (MMS)] and US measurements (DSHB, DSEM, DSAC) in predicting difficult laryngoscopy.ResultsThere were 28 out of 203 patients categorized as difficult laryngoscopy. DSHB, DSEM, DSAC, and MMS were greater in the difficult laryngoscopy group (P<0.0001). There was a strong positive correlation between DSEM and DSHB (r=0.74); moderate positive correlations between DSEM and DSAC (r=0.60), DSHB and DSAC (r=0.69); small positive correlations between MMS and DSHB (r=0.32), MMS and DSEM (r=0.27), MMS and DSAC (r=0.32), all P values ≤0.0001; very small positive correlation between TMD and IIG (r=0.18, P=0.0089); small negative correlation between IIG and MMS (r=−0.27, P=0.0001); and very small negative correlations between MMS and TMD (r=−0.20, P=0.004), IIG and DSAC (r=−0.18, P=0.011), IIG and DSHB (r=−0.15, P=0.034). The areas under the ROC curve (AUCs) of MMS, DSHB, DSEM, and DSAC were significantly larger compared with the reference line (P<0.0001).ConclusionsAnterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryngoscopy. Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy.

Ultrasound guided nerve block in successful anesthetic management of an achondroplasic dwarf with severe kyphoscoliosis.

Sir, A 23-year-old man (weight = 34 kg, height = 119 cm) presented with a history of pain in the right foot and fever since 5 days. He gave a history of abnormalities of the limbs and trunk since birth. On examination, his pulse rate was 74/min, blood pressure = 130/80 mmHg, and there was an abscess of the right foot with cellulitis extending up to the level of calf. He had a short stature, kyphoscoliosis, abnormal and short lower limbs. Cardiovascular and respiratory systems were normal except for deformity of the chest. Airway examination revealed a broad nasal bridge, adequate mouth opening, modified Mallampati score — 2, and normal neck movements. There was a kyphoscoliotic deformity involving the entire spine. His hemoglobin concentration was 12.3 g/dl and total leucocyte count = 25730 cells/cm3. Electrocardiogram showed incomplete right bundle branch block. A radiograph confirmed the kyphoscoliosis involving the entire spine from cervical to the lumbosacral region [Figure 1]. Figure 1 Radiograph showing severe kyphoscoliosis involving the entire spine from cervical to lumbosacral region After initiating routine monitoring, intravenous fentanyl 50 μg and midazolam 1 mg was administered and the patient was put in left lateral position. The right sciatic nerve block was performed at the subgluteal region using a combined ultrasound (out of plane technique) and a peripheral nerve stimulator technique with a 22G 10 cm insulated needle (Stimuplex® A) after eliciting dorsiflexion of the foot. Then, the patient was turned supine and the right femoral nerve block was performed using similar technique (except the in-plane technique for ultrasound) after eliciting contraction of the quadriceps. The local anesthetic mixture contained 12 ml of lignocaine 2% with adrenaline 5 μg/ml + 10 ml of bupivacaine 0.5% + 3 ml of NaHCO3 + 7 ml normal saline (total volume = 32 ml). There were neither any technical difficulties nor any anatomical variations of the nerves noted during the procedure. Drainage of the abscess with debridement up to a few centimeters below the knee was completed successfully in 30 min. However, analgesia lasted only for about 3 h. Achondroplasia is the most common cause for dwarfism with an approximate incidence of 1.5 in 10,000-1 in 40,000 live newborns with majority (80%) of the cases due to spontaneous mutation.[1,2,3,4] Achondroplasia is caused by a genetic mutation of the fibroblast growth factor receptor-3, which affects bone growth due to change in endochondral ossification and leads to bone malformation.[5] Due to the defective bone growth with extensive skeletal involvement, both general, and neuraxial anesthesia for these patients may be associated with several difficulties including difficult airway, laryngomalacia, technically challenging neuraxial anesthesia, unpredictable spread of local anesthetics in the epidural space and subarachnoid space and compromised pulmonary function.[4,5] Even though, there have been a few cases of successful spinal and epidural anesthesia[3] in such patients undergoing caesarean section, various reports have described technical difficulties during the procedure, increased complications[2] unpredictable spread of local anesthetic,[4] and failure of neuraxial anesthesia. Neurological problems may develop later in life because of compression of the cord due to osteophytes, prolapsed intervertebral discs, and deformed vertebral bodies. Therefore, it has been suggested to avoid neuraxial anesthesia in these patients and anesthesiologists have been reluctant to opt for neuraxial anesthesia.

Inter-Observer Reliability of Candidate Predictive Morphometric Measurements for Women with Suspected Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is increasingly recognized as a public health concern. Definitive diagnosis is by overnight polysomnographic (PSG) examination. Identification of clinical predictors would be beneficial in helping prioritize high-risk patients for assessment. Practical application of morphometric predictive variables would require a high level of reproducibility in a clinical setting. In this study, our objective was to evaluate reliability between observers in measurements of candidate morphometric parameters in women. This was a prospective study of 71 women who had been referred for PSG with suspected OSA. Selected morphometric parameters were measured independently in the sleep laboratory by two trained sleep physicians. Neck circumference and truncal measurements for lower costal, midabdominal, and hip circumferences had higher reliability coefficients (intraclass correlation coefficients [ICC] of 0.78, 0.95, 0.95, and 0.81) than the smaller dimension measurements, including cricomental distance or retrognathia (ICC of 0.04 and 0.17). Of the women participating in this study, 50 of 71 had apnea-hypopnea indexes (AHI) ≥ 5. Body mass index (BMI), neck circumference, lower costal girth, midabdominal girth, and hip girth were all significantly higher (p < 0.001-0.004) in women with AHI ≥ 5. There was wide variation in inter-observer reliability for different physical dimensions. We propose that any clinical morphologic measurement employed in predictive modeling should be reliably reproducible in clinical setting conditions. Our findings support the use of several truncal measures, BMI, and neck circumference as predictive measures in women undergoing evaluation for OSA.

A combination of the modified Mallampati score, thyromental distance, anatomical abnormality, and cervical mobility (M-TAC) predicts difficult laryngoscopy better than Mallampati classification

ObjectiveUnanticipated difficult tracheal intubation is a significant source of morbidity and mortality in anesthetized patients. A number of modules have been developed to predict difficult airways, but they are often complex in nature. We combined the modified Mallampati score (M), thyromental distance (T), anatomical abnormality (A), and cervical mobility (C) into a single scoring system with the acronym M-TAC, and evaluated it against Mallampati scoring. MethodsWe prospectively analyzed 500 adult patients of the American Society of Anesthesiologists (ASA) class I or II, scheduled for elective surgery under general anesthesia. Preoperative airway assessments using M-TAC were performed, all of which were given a score. Anesthesiologists, blinded to the pre-anesthetic airway assessment, performed laryngoscopy and graded the laryngoscopic view as per Cormack and Lehane's classification. For the study purpose, difficult laryngoscopy was defined as Cormack and Lehane Grade 3 or 4 of laryngoscopic view. ResultsAn M-TAC score ≥ 4 had a significantly higher sensitivity (96% vs. 72%) and specificity (86% vs. 78%) with a high positive predictive value (44% vs. 28%) and a very low false negative value (2% vs. 15%) in comparison with Mallampati scoring (p < 0.05). Analysis of the receiver operating characteristic (ROC) curve for predicting difficult laryngoscopy revealed an area under the curve of 0.83 (95% CI = 0.78–0.88) for Mallampati scoring and 0.94 (95% CI = 0.92–0.96) for M-TAC scoring system. ConclusionThe M-TAC scoring system has provided a higher sensitivity and specificity in predicting difficult laryngoscopy in comparison with Mallampati classification.

Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing

ObjectivesWe wanted to evaluate whether the presence of nasal obstruction makes a change on the association between the modified Mallampati score and the severity of sleep-disordered breathing (SDB) and the sleep quality.MethodsPolysomnography (PSG), the modified Mallampati score (MMS), the body-mass index, and a questionnaire about nasal obstruction were acquired from 275 suspected SDB patients. The subjects were divided into two groups according to the presence of nasal obstruction. The clinical differences between the two groups were evaluated and the associations between the MMS and PSG variables in each group were also assessed.ResultsSignificant correlations were found between the MMS and many PSG variables, including the apnea-hypopnea index, the arousal index and the proportion of deep sleep, for the patients with nasal obstruction, although this was not valid for the total patients or the patients without nasal obstruction.ConclusionThe severity of SDB and the quality of sleep are well correlated with the MMS, and especially for the patients with nasal obstruction. The MMS can give more valuable information about the severity of SDB when combined with simple questions about nasal obstruction.

Awake intubation with video-assisted laryngoscope or intubating stylet

For anesthesiologists, it is inevitable to confront with various difficult conditions during mask ventilation and intubation. Therefore, anesthesiologists perform a variety of airway examinations and history taking to anticipate and to overcome demanding situations. Yet, the parameters obtained from such measurements are not satisfactory. In patients having the conditions that indicate difficult intubation, awake intubation is performed especially when the plausibility of mask ventilation is uncertain. Awake fiberoptic intubation has been adopted for management of anticipated difficult tracheal intubation. However, fiberoptic bronchoscope requires higher cost and longer time to learn the technique. Recently, laryngoscope or stylet with video system is used in various situations, including difficult intubation. Also, in awake intubation, some cases with video-assisted laryngoscope have been reported. Successful awake video-assisted laryngoscopic intubation has been performed in patients with limited neck extention and Mallampati grade 4 [1]. Also, Park et al. [2] reported a case of a patient with restricted mouth opening, nearly fixed neck movement and regressed mandible due to scar contracture where intubation was performed with the use of fiberoptic bronchoscopy under GlideScope® video laryngoscope guidance. Recently, Rosenstock reported that in 93 patients with an anticipated difficult intubation, there is no difference in patients' discomfort, ease of the technique and intubation success rate on the first attempt between the awake video-assisted laryngoscopic intubation and awake fiberoptic intubation [3]. Case reports with awake intubation using video-assisted intubating stylet are still rare. There is a case report that reported successful awake intubation with video-assisted intubating stylet in a patient with fixed neck due to halo vest and limited mouth opening (3 cm), in addition to modified Mallampati score grade 4 [4]. Smaller diameter of video-assisted intubating stylet can be applied to patients with more limited mouth opening or loose tooth than video-assisted laryngoscope. Video-assisted intubating stylet provided faster and easier intubations than the video-assisted laryngoscope in patients with limited neck motion [5]. In oral, laryngeal, glottic, supraglottic cancer, cancer bleeding during intubation procedure often interfere with the laryngoscopic view. In such situation, owing to smaller volume than video laryngoscope, the video-assisted intubating stylet is helpful to avoid injuring the mass and to overcome potentially traumatic airway manipulation. Patient preparation for awake intubation with video-assisted laryngoscope or intubating stylet is same as the preparation of awake fiberoptic intubation: antisialogue, oxygen supplement, topical application and transtracheal injection of local anesthetics. For adequate sedation and analgesia, combination of short acting opioids (eg. remifentanil) and sedatives (eg. propofol, or midazolam) infusion can be administered intravenously. Video-assisted laryngoscope or video-assisted stylet has an external monitor, and the supervisor can see the anatomy together and educate intubation skills on a case-by-case basis. With sufficient training of stylet usage, the quick and easy to use new instrument, such as video-assisted stylet, is expected to be selected as an alternative awake intubating device instead of the flexible fiberscope that requires longer time to learn. However, the currently used video-assisted laryngoscope and intubating stylet do not have the suction function. Therefore, preparations to prevent oral secretion are more important, and the assistant should help the oral suction of secretion or bleeding. In this respect, it is required to develop video-assisted laryngoscope or intubating stylet with the suction function in the near future.

Drug-induced sleep endoscopy in adults with sleep-disordered breathing: Technique and the VOTE Classification system

Drug-induced sleep endoscopy (DISE) offers an unique evaluation of the upper airway. After pharmacologic induction of unconscious sedation, it is possible to evaluate endoscopically the structures contributing to upper airway obstruction in sleep disordered breathing. The authors describe DISE techniques and the VOTE classification system for reporting of DISE findings. The VOTE classification focuses on the primary structures that contribute to upper airway obstruction and represents a common language to describe the patterns of obstruction during DISE. The latter can facilitate the scientific evaluation of DISE, including its role in directing treatment.

Easy and difficult nasal intubation – a randomised comparison of Macintosh vs Airtraq® laryngoscopes*

A new Airtraq(®) laryngoscope has been developed for nasal intubation. We prospectively compared tracheal intubation efficiency of the Airtraq for nasotracheal intubation vs that of the Macintosh laryngoscope in 200 patients. Depending on pre-operative airway evaluation, the patients were allocated to expected easy (n = 100) or difficult (n = 100) intubation groups, on the basis of mouth opening ≤ 2.5 cm, modified Mallampati score of 4, history of difficult intubation, obvious tumour or swelling. Patients were randomly allocated to the Macintosh or nasotracheal Airtraq technique. All easy intubations were successfully performed with the respective technique. In the expected difficult intubation group, the success rate was higher (47/50 vs 33/50; p < 0.01), the glottis view was better (Cormack and Lehane 1/2/3/4 grades: 29/17/1/3 vs 5/11/18/16, p < 0.01), mean (SD) intubation time was shorter (45(46) s vs 77(47)s, p < 0.01) and the number of optimising manoeuvres was reduced with the nasotracheal Airtraq compared with the Macintosh, respectively. For difficult nasal intubations, the nasotracheal Airtraq is more effective than the Macintosh laryngoscope.

Is High Modified Mallampati Score A Risk Factor for Arterial Hypertension?

Is High Modified Mallampati Score A Risk Factor for Arterial Hypertension?

Pilot Study to Determine the Utility of Point‐of‐care Ultrasound in the Assessment of Difficult Laryngoscopy

Prediction of difficult laryngoscopy in emergency care settings is challenging. The preintubation clinical screening tests may not be applied in a large number of emergency intubations due to the patient's clinical condition. The objectives of this study were 1) to determine the utility of sonographic measurements of thickness of the tongue, anterior neck soft tissue at the level of the hyoid bone, and thyrohyoid membrane in distinguishing difficult and easy laryngoscopies and 2) to examine the association between sonographic measurements (thickness of tongue and anterior neck soft tissue) and difficult airway clinical screening tests (modified Mallampati score, thyromental distance, and interincisor gap). This was a prospective observational study at an academic medical center. Adult patients undergoing endotracheal intubation for an elective surgical procedure were included. The investigators involved in data collection were blinded to each other's assessments. Demographic variables were collected preoperatively. The clinical screening tests to predict a difficult airway were performed. The ultrasound (US) measurements of tongue and anterior neck soft tissue were obtained. The laryngoscopic view was graded using Cormack and Lehane classification by anesthesia providers on the day of surgery. To allow for comparisons between difficult airway and easy airway groups, a two-sided Student's t-test and Fisher's exact test were employed as appropriate. Spearman's rank correlation coefficients were used to examine the association between screening tests and sonographic measurements. The mean (±standard deviation [SD]) age of 51 eligible patients (32 female, 19 male) was 53.1 (±13.2) years. Six of the 51 patients (12%, 95% confidence interval [CI] = 3% to 20%) were classified as having difficult laryngoscopy by anesthesia providers. The distribution of laryngoscopy grades for all subjects was 63, 25, 4, and 8% for grades 1, 2, 3, and 4, respectively. In this study, 83% of subjects with difficult airways were males. No other significant differences were noted in the demographic variables and difficult airway clinical screening tests between the two groups. The sonographic measurements of anterior neck soft tissue were greater in the difficult laryngoscopy group compared to the easy laryngoscopy group at the level of the hyoid bone (1.69, 95% CI = 1.19 to 2.19 vs. 1.37, 95% CI = 1.27 to 1.46) and thyrohyoid membrane (3.47, 95% CI = 2.88 to 4.07 vs. 2.37, 95% CI = 2.29 to 2.44). No significant correlation was found between sonographic measurements and clinical screening tests. This pilot study demonstrated that sonographic measurements of anterior neck soft tissue thickness at the level of hyoid bone and thyrohyoid membrane can be used to distinguish difficult and easy laryngoscopies. Clinical screening tests did not correlate with US measurements, and US was able to detect difficult laryngoscopy, indicating the limitations of the conventional screening tests for predicting difficult laryngoscopy.

Morphological features of elderly patients with obstructive sleep apnoea syndrome: a prospective controlled, comparative cohort study

To investigate the pharyngeal morphologic features and its pathogenic role on obstructive sleep apnoea syndrome in the elderly population. Prospective controlled, comparative cohort study. Territory referral centre. We enroled 320 consecutive patients with complaints of snoring who visited Nagoya University Hospital from January 2004 to December 2007. We also collected 26 control subjects aged over 60 years from community-dwelling people. We underwent a morphological evaluation, measurement of nasal resistance, assessment of daytime sleepiness and nocturnal polysomnography. Two hundred and ninety-two patients were analysed. The constitution ratio of men, the body mass index and Epworth sleepiness scale were decreased with ageing. Tonsil size was reduced progressively with ageing. Retroglossal space was wider, and soft palate was lower in ≥ 60 year group than in < 40 year group. Retroglossal space was wide in elderly patients with sleep apnoea compared with control subjects. Tonsil size was not correlated to apnoea/hypopnoea index in ≥ 60 year group unlike the other generations. Modified Mallampati Score and tongue size were significantly but mildly correlated only in ≥ 60 year group. Width of fauces was correlated in all the groups. Multiple regression analysis showed that body mass index, age, gender, tonsil size and width of fauces were independent factors for apnoea/hypopnoea index. Morphologically, the tonsil could play a minor role but the width of fauces could play relatively a major role. Additionally, wide retroglossal space, low positional soft palate and large tongue size may be characteristics for elderly patients of obstructive sleep apnoea syndrome.

Reliability of Patient Self-Assessment for Modified Mallampati Score

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

UTILITY OF MODIFIED MALLAMPATI SCORE IN PREDICTING OBSTRUCTIVE SLEEP APNEA IN AFRICAN-AMERICANS

PURPOSE: Mallampati score is often used as a tool to predict the likelihood of obstructive sleep apnea (OSA). However studies have revealed cranio-facial differences between Caucasians and African-Americans. This study attempts to look at the effectiveness of modified mallampati score in predicting OSA in African-American (AA) population.

Avoidance of neuromuscular blocking agents may increase the risk of difficult tracheal intubation: a cohort study of 103 812 consecutive adult patients recorded in the Danish Anaesthesia Database

Previous studies indicate that avoiding neuromuscular blocking agents (NMBAs) may be a risk factor for difficult tracheal intubation (DTI). We investigated whether avoiding NMBA was associated with DTI. A cohort of 103,812 consecutive patients planned for tracheal intubation by direct laryngoscopy was retrieved from the Danish Anaesthesia Database. We used an intubation score based upon the number of attempts, change from direct laryngoscopy to a more advanced technique, or intubation by a different operator. We retrieved data on age, sex, ASA physical status classification, priority of surgery, time of surgery, previous DTI, modified Mallampati score, BMI, and the use of NMBA. Using logistic regression, we assessed whether avoiding NMBA was associated with DTI. The frequency of DTI was 5.1 [95% confidence interval (CI): 5.0-5.3]%. In a univariate analysis, avoiding NMBA was associated with DTI, odds ratio (OR) 1.52 (95% CI: 1.43-1.61)%, P<0.0001. Using multivariate analysis, avoiding NMBA was associated with DTI, OR 1.48 (95% CI: 1.39-1.58), P<0.0001. Among patients intubated using NMBA, a multivariate analysis identified patients anaesthetized with only non-depolarizing NMBA to be more at risk for DTI than those anaesthetized with depolarizing NMBA alone. Avoiding NMBA may increase the risk of DTI. However, confounding by indication may be a problem in this observational study and systematic reviews with meta-analysis or more randomized clinical trials are needed.

Pharyngeal morphology: A determinant of successful nasal surgery for sleep apnea

To estimate the effectiveness of nasal surgery on the occurrence of sleep apnea, and to analyze the pharyngeal morphology of apnea patients whose sleep-disordered breathing was ameliorated postoperatively. Prospective study. Thirty-five consecutive patients with apnea and nasal obstruction underwent polysomnography and a morphological examination of the upper airway before and after nasal surgery, which included septoplasty, inferior turbinectomy, and/or functional endoscopic sinus surgery. Sleep apnea was significantly ameliorated in only eight patients. The postoperative reduction in the apnea-hypopnea index tended to be lower in those with a low-positioned soft palate, reflected in an elevated modified Mallampati score, and a narrow retroglossal space. Neither swollen tonsils nor narrow fauces affected the surgical outcome. Regression analysis showed that the modified Mallampati score (P < .05) and the retroglossal space (P < .05) were significant predictors of postoperative improvement in the apnea-hypopnea index. Among sleep apnea patients suffering from nasal obstruction, nasal surgery is effective in those with a high-positioned soft palate and/or a wide retroglossal space.

Extended vs. Standard Mallampati Scoring for Morbidly Obese Patients

Both the four-point modified Mallampati Score (MMP; assessed with the neck in neutral position) and the extended Mallampati Score (EMS; assessed with

The diagnostic accuracy of previously difficult intubation and modified Mallampati score in predicting the difficult tracheal intubation of 91,322 consecutive patients from the Danish Anaesthesia Database

The diagnostic accuracy of previously difficult intubation and modified Mallampati score in predicting the difficult tracheal intubation of 91,322 consecutive patients from the Danish Anaesthesia Database

Predisposing Factors of Sleep‐Disordered Breathing in Japanese Male Workers

The aim of this study was to elucidate the usable predisposing factors of sleep-disordered breathing (SDB) in the workplace. A total of 353 male workers who complained of SDB related symptoms such as witnessed snoring, recurrent awakening from sleep, urination during the night, morning headache, and excessive daytime sleepiness were included in the analysis. We examined hyoid-mental distance (HMD), modified Mallampati score (MMS), and the narrowness of the pharynx with tonsillar hypertrophy as the predisposing physical findings of SDB. We used the number of 3% or more oxygen desaturation events per hour (ODI3) as the indicator of SDB. The mean values (S.D.) of all subjects were 44.3 (8.9) yr (19-66 yr) of age, and 25.9 (3.8) Kg/m(2) body mass index (BMI). A significant difference in ODI3 was found between the HMD classes, and also between the subjects with and without tonsillar hypertrophy. Mean ODI3 adjusted for age, BMI, and alcohol consumption on the day of monitoring was high in the group of short HMD and the group of tonsillar hypertrophy (+). For MMS, though ODI3 did not appear to be significantly different, mean ODI3 was high in the MMS-IV. In conclusion, short HMD and tonsillar hypertrophy are the important findings predicting SDB identified by pulse oximetry. These findings would be beneficial in the workplace for selection of subjects who should be encouraged to undergo pulse oximetry for detection of SDB.