Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies
Difficult airway management and obstructive sleep apnea may contribute to increased risk of perioperative morbidity and mortality. The objective of this systematic review and meta-analysis (SRMA) is to evaluate the evidence of a difficult airway being associated with obstructive sleep apnea (OSA) pa...
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| creator | Nagappa, Mahesh Wong, David T Cozowicz, Crispiana Ramachandran, Satya Krishna Memtsoudis, Stavros G Chung, Frances |
| description | Difficult airway management and obstructive sleep apnea may contribute to increased risk of perioperative morbidity and mortality. The objective of this systematic review and meta-analysis (SRMA) is to evaluate the evidence of a difficult airway being associated with obstructive sleep apnea (OSA) patients undergoing surgery.
The standard databases were searched from 1946 to April 2017 to identify the eligible articles. The studies which included adult surgical patients with either suspected or diagnosed obstructive sleep apnea must report at least one difficult airway event [either difficult intubation (DI), difficult mask ventilation (DMV), failed supraglottic airway insertion or difficult surgical airway] in sleep apnea and non-sleep apnea patients were included.
Overall, DI was 3.46-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 13.5% vs 2.5%; OR 3.46; 95% CI: 2.32-5.16, p |
| doi_str_mv | 10.1371/journal.pone.0204904 |
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The standard databases were searched from 1946 to April 2017 to identify the eligible articles. The studies which included adult surgical patients with either suspected or diagnosed obstructive sleep apnea must report at least one difficult airway event [either difficult intubation (DI), difficult mask ventilation (DMV), failed supraglottic airway insertion or difficult surgical airway] in sleep apnea and non-sleep apnea patients were included.
Overall, DI was 3.46-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 13.5% vs 2.5%; OR 3.46; 95% CI: 2.32-5.16, p <0.00001). DMV was 3.39-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 4.4% vs 1.1%; OR 3.39; 95% CI: 2.74-4.18, p <0.00001). Combined DI and DMV was 4.12-fold higher in the OSA vs. non-OSA patients (OSA vs. non-OSA: 1.1% vs 0.3%; OR 4.12; 95% CI: 2.93-5.79, p <0.00001). There was no significant difference in the supraglottic airway failure rates in the sleep apnea vs non-sleep apnea patients (OR: 1.34; 95% CI: 0.70-2.59; p = 0.38). Meta-regression to adjust for various subgroups and baseline confounding factors did not impact the final inference of our results.
This SRMA found that patients with obstructive sleep apnea had a three to four-fold higher risk of difficult intubation or mask ventilation or both, when compared to non-sleep apnea patients.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0204904</identifier><identifier>PMID: 30286122</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Airway management ; Airway Management - instrumentation ; Airway obstruction ; Anesthesia ; Anesthesiology ; Apnea ; Cohort analysis ; Critical care ; Failure rates ; Female ; Health care networks ; Hospitals ; Humans ; Intensive care ; Intubation ; Male ; Medicine ; Medicine and Health Sciences ; Meta-analysis ; Middle Aged ; Morbidity ; Neck ; Pain management ; Patients ; Physical Sciences ; Polysomnography ; Postoperative Complications - mortality ; Prospective Studies ; Regression analysis ; Research and Analysis Methods ; Respiratory tract ; Retrospective Studies ; Risk Factors ; Sleep ; Sleep apnea ; Sleep Apnea, Obstructive - complications ; Sleep Apnea, Obstructive - surgery ; Sleep disorders ; Subgroups ; Surgery ; Systematic review ; Task forces ; Treatment Outcome ; Ventilation ; Ventilators</subject><ispartof>PloS one, 2018-10, Vol.13 (10), p.e0204904-e0204904</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Nagappa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Nagappa et al 2018 Nagappa et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-1f843acf09e86b0307a3b275a5e0b944c5a1fe525e4a7ae39f5f6eac12206eb73</citedby><cites>FETCH-LOGICAL-c692t-1f843acf09e86b0307a3b275a5e0b944c5a1fe525e4a7ae39f5f6eac12206eb73</cites><orcidid>0000-0001-9576-3606 ; 0000-0002-8058-4135</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171874/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171874/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30286122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nagappa, Mahesh</creatorcontrib><creatorcontrib>Wong, David T</creatorcontrib><creatorcontrib>Cozowicz, Crispiana</creatorcontrib><creatorcontrib>Ramachandran, Satya Krishna</creatorcontrib><creatorcontrib>Memtsoudis, Stavros G</creatorcontrib><creatorcontrib>Chung, Frances</creatorcontrib><title>Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Difficult airway management and obstructive sleep apnea may contribute to increased risk of perioperative morbidity and mortality. The objective of this systematic review and meta-analysis (SRMA) is to evaluate the evidence of a difficult airway being associated with obstructive sleep apnea (OSA) patients undergoing surgery.
The standard databases were searched from 1946 to April 2017 to identify the eligible articles. The studies which included adult surgical patients with either suspected or diagnosed obstructive sleep apnea must report at least one difficult airway event [either difficult intubation (DI), difficult mask ventilation (DMV), failed supraglottic airway insertion or difficult surgical airway] in sleep apnea and non-sleep apnea patients were included.
Overall, DI was 3.46-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 13.5% vs 2.5%; OR 3.46; 95% CI: 2.32-5.16, p <0.00001). DMV was 3.39-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 4.4% vs 1.1%; OR 3.39; 95% CI: 2.74-4.18, p <0.00001). Combined DI and DMV was 4.12-fold higher in the OSA vs. non-OSA patients (OSA vs. non-OSA: 1.1% vs 0.3%; OR 4.12; 95% CI: 2.93-5.79, p <0.00001). There was no significant difference in the supraglottic airway failure rates in the sleep apnea vs non-sleep apnea patients (OR: 1.34; 95% CI: 0.70-2.59; p = 0.38). Meta-regression to adjust for various subgroups and baseline confounding factors did not impact the final inference of our results.
This SRMA found that patients with obstructive sleep apnea had a three to four-fold higher risk of difficult intubation or mask ventilation or both, when compared to non-sleep apnea patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Airway management</subject><subject>Airway Management - instrumentation</subject><subject>Airway obstruction</subject><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Apnea</subject><subject>Cohort analysis</subject><subject>Critical care</subject><subject>Failure rates</subject><subject>Female</subject><subject>Health care networks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intubation</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Neck</subject><subject>Pain management</subject><subject>Patients</subject><subject>Physical Sciences</subject><subject>Polysomnography</subject><subject>Postoperative Complications - mortality</subject><subject>Prospective Studies</subject><subject>Regression analysis</subject><subject>Research and Analysis Methods</subject><subject>Respiratory tract</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sleep</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - complications</subject><subject>Sleep Apnea, Obstructive - surgery</subject><subject>Sleep disorders</subject><subject>Subgroups</subject><subject>Surgery</subject><subject>Systematic review</subject><subject>Task forces</subject><subject>Treatment Outcome</subject><subject>Ventilation</subject><subject>Ventilators</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk89u1DAQxiMEoqXwBggsISE47GLHsZNcQFVVYKVKlfh3tSbOZNdVEgfb2WXfhkfFYbfVLuoB5eBo_Jvv84w9SfKc0TnjOXt3Y0fXQzsfbI9zmtKspNmD5JSVPJ3JlPKHB_8nyRPvbygVvJDycXLCaVpIlqanye-FJ7bywY06mDUS3yIOBIYegYD3VhsIWJONCStSm6YxemwDAeM2sP1ALtemxl4jaZztCBC_9QE7CEYTh2uDGwJ9TToMMIN41q030a0hg7N-wJ3hBDgMBxFtV9YF4sNYG_RPk0cNtB6f7dez5PvHy28Xn2dX158WF-dXMy3LNMxYU2QcdENLLGRFOc2BV2kuQCCtyizTAliDIhWYQQ7Iy0Y0EkHHJlCJVc7Pkpc73aG1Xu2b61XKmMxYJjmLxGJH1BZu1OBMB26rLBj1N2DdUoGLpbeoilRSyHlBNa-yHBGgEELWtWQVZrKWUev93m2sOqw19sFBeyR6vNOblVratZIsZ0WeRYE3ewFnf47og-qM19i20KMdd-cuBC3FVNmrf9D7q9tTS4gFmL6x0VdPoupciFwWXPDJdn4PFb8aO6PjS2xMjB8lvD1KiEzAX2EJo_dq8fXL_7PXP47Z1wfsCqENK2_bMRjb-2Mw24E6PjHvsLlrMqNqGqTbbqhpkNR-kGLai8MLuku6nRz-BzLDHF4</recordid><startdate>20181004</startdate><enddate>20181004</enddate><creator>Nagappa, Mahesh</creator><creator>Wong, David T</creator><creator>Cozowicz, Crispiana</creator><creator>Ramachandran, Satya Krishna</creator><creator>Memtsoudis, Stavros G</creator><creator>Chung, Frances</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-9576-3606</orcidid><orcidid>https://orcid.org/0000-0002-8058-4135</orcidid></search><sort><creationdate>20181004</creationdate><title>Is obstructive sleep apnea associated with difficult airway? 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nagappa, Mahesh</au><au>Wong, David T</au><au>Cozowicz, Crispiana</au><au>Ramachandran, Satya Krishna</au><au>Memtsoudis, Stavros G</au><au>Chung, Frances</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-10-04</date><risdate>2018</risdate><volume>13</volume><issue>10</issue><spage>e0204904</spage><epage>e0204904</epage><pages>e0204904-e0204904</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Difficult airway management and obstructive sleep apnea may contribute to increased risk of perioperative morbidity and mortality. The objective of this systematic review and meta-analysis (SRMA) is to evaluate the evidence of a difficult airway being associated with obstructive sleep apnea (OSA) patients undergoing surgery.
The standard databases were searched from 1946 to April 2017 to identify the eligible articles. The studies which included adult surgical patients with either suspected or diagnosed obstructive sleep apnea must report at least one difficult airway event [either difficult intubation (DI), difficult mask ventilation (DMV), failed supraglottic airway insertion or difficult surgical airway] in sleep apnea and non-sleep apnea patients were included.
Overall, DI was 3.46-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 13.5% vs 2.5%; OR 3.46; 95% CI: 2.32-5.16, p <0.00001). DMV was 3.39-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 4.4% vs 1.1%; OR 3.39; 95% CI: 2.74-4.18, p <0.00001). Combined DI and DMV was 4.12-fold higher in the OSA vs. non-OSA patients (OSA vs. non-OSA: 1.1% vs 0.3%; OR 4.12; 95% CI: 2.93-5.79, p <0.00001). There was no significant difference in the supraglottic airway failure rates in the sleep apnea vs non-sleep apnea patients (OR: 1.34; 95% CI: 0.70-2.59; p = 0.38). Meta-regression to adjust for various subgroups and baseline confounding factors did not impact the final inference of our results.
This SRMA found that patients with obstructive sleep apnea had a three to four-fold higher risk of difficult intubation or mask ventilation or both, when compared to non-sleep apnea patients.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30286122</pmid><doi>10.1371/journal.pone.0204904</doi><tpages>e0204904</tpages><orcidid>https://orcid.org/0000-0001-9576-3606</orcidid><orcidid>https://orcid.org/0000-0002-8058-4135</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2018-10, Vol.13 (10), p.e0204904-e0204904 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2116414631 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adult Aged Airway management Airway Management - instrumentation Airway obstruction Anesthesia Anesthesiology Apnea Cohort analysis Critical care Failure rates Female Health care networks Hospitals Humans Intensive care Intubation Male Medicine Medicine and Health Sciences Meta-analysis Middle Aged Morbidity Neck Pain management Patients Physical Sciences Polysomnography Postoperative Complications - mortality Prospective Studies Regression analysis Research and Analysis Methods Respiratory tract Retrospective Studies Risk Factors Sleep Sleep apnea Sleep Apnea, Obstructive - complications Sleep Apnea, Obstructive - surgery Sleep disorders Subgroups Surgery Systematic review Task forces Treatment Outcome Ventilation Ventilators |
| title | Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies |
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