Association of Obstructive Sleep Apnea With Difficult Intubation: Prospective Multicenter Observational Cohort Study

Area of Science:

• Anesthesiology
• Sleep Medicine
• Pulmonology

Background:

• Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for difficult airways.
• Limited prospective studies exist on OSA severity thresholds and difficult airway outcomes.
• This study investigates the association between OSA severity and difficult intubation/mask ventilation.

Purpose of the Study:

• To examine the association between obstructive sleep apnea (OSA) severity and difficult intubation or mask ventilation.
• To evaluate the predictive utility of the STOP-Bang score for difficult airway outcomes in surgical patients.

Main Methods:

• Prospective cohort study (POSA trial) of 869 surgical patients aged 45+ with cardiac risk factors.
• Patients underwent sleep studies and STOP-Bang screening.
• Multivariable logistic regression analyzed OSA severity and STOP-Bang scores against difficult intubation and mask ventilation outcomes.

Main Results:

• Moderate and severe OSA were independently associated with difficult intubation (OR 3.26 and 4.05, respectively).
• Higher STOP-Bang scores (3-4 and 5-8) were associated with increased odds of difficult intubation compared to low scores (0-2).
• OSA was not linked to difficult mask ventilation; only increased neck circumference showed association (adjusted P = .002).

Conclusions:

• Moderate to severe OSA is a significant predictor of difficult intubation.
• The STOP-Bang score may aid in identifying patients at higher risk for difficult intubation.
• Anesthesiologists should maintain vigilance for difficult intubation in OSA patients.