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J Clin Anesth. 2018 Mar;45:63-68. doi: 10.1016/j.jclinane.2017.12.024. Epub 2018 Jan 4.

Obstructive sleep apnea as a risk factor associated with difficult airway management - A narrative review.

Author information

1
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Anaesthesia, National University Hospital, National University Health System, Singapore.
2
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Anaesthesia, The Townsville Hospital and Health Services, James Cook University, Townsville, Queensland, Australia.
3
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
4
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: david.wong@uhn.ca.

Abstract

STUDY OBJECTIVE:

The association between obstructive sleep apnea (OSA) and difficult airway had been studied in various clinical trials but the relationship between the two conditions has not been clearly established. The objective of this narrative review is to determine if OSA is a risk factor associated with difficult airway.

DESIGN:

The OVID Medline in process, Medline (vis Pub Med), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched up to April 2016 using specific keywords. Inclusion criteria were: [1] airway management in patients with a diagnosis of OSA, [2] comparison of airway management between OSA and non-OSA patients, [3] publications or abstracts in the English language. The incidence of difficult airway between OSA and non-OSA patients was compared using Chi-square analysis or Fisher's exact test.

MAIN RESULTS:

Ten studies were included in the final review. Overall, the incidence of difficult tracheal intubation was higher in OSA patients versus non-OSA patients [56/386 (14.5%) vs. 69/897 (7.7%); P=0.0002]. OSA patients also have a higher incidence of difficult mask ventilation [115/4626 (2.5%) vs. 471/64,684 (0.7%); P<0.0001]. Compared to non-OSA patients, OSA was not associated with difficulty in the use of a supraglottic airway (SGA) device [10/663 (1.5%) vs. 162/15,171 (1.1%); P=0.38]. No studies compared difficult surgical airway in OSA and non-OSA patients.

CONCLUSIONS:

OSA was found to be a risk factor associated with difficult tracheal intubation and difficult mask ventilation. There was no association between OSA and difficult SGA use.

KEYWORDS:

Airway management; Difficult airway; Difficult intubation; Difficult mask ventilation; Obstructive sleep apnea

PMID:
29291467
DOI:
10.1016/j.jclinane.2017.12.024
[Indexed for MEDLINE]

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