Incidence of difficult airway among adult patients of undiagnosed obstructive sleep apnea who undergo elective surgery in Public hospitals of Addis Ababa, Ethiopia, from February to April 2021
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Date
2021-06
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Addis Ababa University
Abstract
Introduction: Obstructive sleep apnea (OSA) is a serious clinical condition characterized by repeated episodes of partial/complete obstruction of the upper airway during sleep and is more undiagnosed in patients undergoing surgery. The occurrence of difficult airway leads to significant morbidity and
mortality in the perioperative period and there is a higher occurrence of difficult airway among OSA
patients. Thus, identification of suspected OSA patients during preoperative evaluation would necessitate adequate preparation and prevents this unwanted outcome.
Objective: To compare the incidence of difficult airway among adult patients of undiagnosed OSA
undergoing elective surgery in public hospitals of Addis Ababa, Ethiopia, from February 1/2021 to April 30/2021.
Method: A multi-center prospective cohort study was conducted at Addis Ababa public hospitals,
Ethiopia, in adult patients of American Society of Anesthesiologist physical status class I and II. The study population was divided into high and low-risk OSA groups based on STOP-BANG score ≥3 and <3 respectively. The incidence of the difficult airway was compared between study groups. Statistical analysis was done by using SPSS version 23. Median was used for Continuous data and frequencies,
number, or percentage was used for categorical variables. Chi-square/Fischer exact test was used to compare categorical data. Mann–Whitney U test was used to compare continuous data. Logistic regression was done to determine factors predicting difficult airway. P-value less than 0.05 was taken as significant.
Result: A total of 113 patients were enrolled in this study. Based on the STOP-BANG score, patients were grouped into high-risk OSA (36 patients) and low-risk OSA (77 patients). Among this difficult ntubation was 22.2% in high-risk OSA versus 5.2% in low-risk OSA, (p=0.017). Difficult mask
ventilation was significantly higher in the high-risk OSA group than the low-risk OSA group (25% versus 6.5%), (p=0.011). Male gender, neck circumference>40cm, Mallampati class 3, and sternomental distance<12.5cm were predictors of difficult intubation. Whereas, Age>50 years, history of snoring, and neck circumference>40cm were predictors of difficult mask ventilation.
Conclusion: The occurrence of difficult intubation and difficult mask ventilation was significantly higher in patients with STOP-BANG score of 3/more. Therefore, every adult patient who undergoes elective surgery is advised to be screened for OSA by STOP-BANG questionnaire.
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Keywords
Obstructive sleep apnea, difficult airway, general anesthesia, STOP-BANG, surgery