Combination of STOP-BANG score and mandibulohyoid distance in the prediction of difficult airway among obstructive sleep apnea patients

  • Kok Tong Lee Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.
  • Rhendra Hardy Mohamad Zaini Hospital Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.
  • Wan Mohd Nazaruddin Wan Hassan Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.
  • Chandran Nadarajan
  • Yee Cheng Kueh Biostatistic Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.
  • Lee Min Foo Hospital Raja Perempuan Zainab II, 15200 Kota Bharu, Kelantan, Malaysia.
  • Mohamad Ibariyah Iberahim Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
  • Soon Eu Chong Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Penang, Malaysia.
Keywords: Airway assessment, Difficult airway, STOP-BANG, Lateral cephalometry, Mandibulohyoid distance, Obstructive sleep apne

Abstract

Objective: This study was designed to evaluate the diagnostic performance of STOPBANG score and mandibulohyoid distance (MHD) towards difficult laryngoscopy among obstructive sleep apnea patients.
Cross-Sectional Study
Methodology: Forty-one patients who had STOP-BANG scores of >3 and required tracheal intubation for general anesthesia were recruited in this cross-sectional study. MHD was measured through lateral cephalometry. After induction of anesthesia, an anesthesiologist who was blinded to the patient’s profile performed a laryngoscopy and evaluated the Cormack-Lehane grading. Sensitivity, specificity, positive and negative predictive values were determined for STOP-BANG and MHD. Binary logistic regression, receiver operating characteristics (ROC) and correlation analyses were employed. 
Results: Body mass index, neck circumference, and Mallampati scores were higher in the difficult laryngoscopy group. MHD was longer in difficult laryngoscopy group (25.40 ± 5.67 mm) than easy laryngoscopy group (20.17 ± 4.28 mm; p = 0.002). STOPBANG score was higher in difficult laryngoscopy group (5.86 ± 0.96 vs. 4.30 ± 0.98; p < 0.001). The combination of MHD and STOP-BANG score improved the quality of diagnostic test in predicting the laryngoscopy status with area under ROC of 87.6%, compared to each isolated parameter (i.e., MHD = 75.7%, STOP-BANG = 85.5%). Both MHD and STOP-BANG scores were significantly positive correlated (r = 0.42, p = 0.006).
Conclusions: STOP-BANG score and MHD were useful in predicting difficult intubation. The diagnostic performance improved further when combining both parameters.
Citation: Lee KT, Zaini RHM, Wan Hassan WMN, Nadarajan C, Kueh YC, Foo LM, Iberahim MI, Chong SE. Combination of STOP-BANG score and mandibulohyoid distance in the prediction of difficult airway among obstructive sleep apnea patients. Anaesth. pain & intensive care 2019;23(2):204-210

Published
11-05-2019
How to Cite
Lee, K. T., Mohamad Zaini, R. H., Wan Hassan, W. M. N., Nadarajan, C., Kueh, Y. C., Foo, L. M., Iberahim, M. I., & Chong, S. E. (2019). Combination of STOP-BANG score and mandibulohyoid distance in the prediction of difficult airway among obstructive sleep apnea patients. Anaesthesia, Pain & Intensive Care, 23(2), 204-210. Retrieved from https://www.apicareonline.com/index.php/APIC/article/view/1071
Issue
Vol. 23, No. 2 June 2019
Section
ORIGINAL RESEARCH